Colour of bile vomiting in intestinal obstruction in the newborn : questionnaire study

Walker, Gregor M and Neilson, Andrew and Young, David and Raine, Peter A M (2006) Colour of bile vomiting in intestinal obstruction in the newborn : questionnaire study. British Medical Journal, 332 (7554). pp. 1363-1365. ISSN 0959-8146 (

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Objectives: To identify the colour that different groups of observers thought represented bile in a newborn's vomit. Design: Questionnaires displaying eight colours (pale yellow to dark green). Setting: General practices in Glasgow, postnatal ward and level III special care baby unit in a university teaching hospital, and mother and toddler groups in Glasgow. Participants: 47 general practitioners, 29 nurses on the baby unit, 48 midwives, and 41 mothers of babies and infants. Outcome measures: Participants indicated which colour would represent bile in a baby's vomit. More than one colour could be chosen. Respondents were also asked to indicate one colour that was the best match for bile. Results: When any colour could be chosen, 12 (25%) general practitioners, 1 (3%) nurse on the baby unit, 5 (10%) postnatal midwives, and 23 (56%) parents did not consider green an appropriate colour for a baby's vomit containing bile. Twenty three (49%) general practitioners, 7 (24%) neonatal nurses, 15 (31%) postnatal midwives, and 29 (71%) parents thought yellow was the best colour match. Conclusions: There is little agreement about the colour of bile vomit in a newborn. It is more pertinent to ask parents about the colour of vomit rather than whether it contained bile. Many general practitioners and parents do not recognise green as an appropriate colour for bile in the vomit of newborns, which may delay surgical referral. Though yellow vomit does not exclude intestinal obstruction, the presence of green vomiting in a baby is a surgical emergency and requires expeditious referral.