It's difficult being green (as in vomit)

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7556.1510-b (Published 22 June 2006) Cite this as: BMJ 2006;332:1510
  1. Carl A Kuschel, clinical director, newborn services (CarlK{at}adhb.govt.nz),
  2. Barbara Cormack, dietitian,
  3. Phil Morreau, paediatric surgeon
  1. Auckland District Health Board, Auckland 1001, New Zealand
  2. Auckland District Health Board, Auckland 1001, New Zealand

    EDITOR—Walker et al evaluated the colour of vomit in newborn infants, and the perception of health professionals on whether it constituted bile.1

    In our neonatal intensive care unit (and on the postnatal wards) we had noted that there was a wide variation in what was being called “bile.” Feeds were withheld unnecessarily in some infants—particularly very small preterm infants, in whom some discoloration of their gastric aspirates is common—whereas in others they were continued when frank bile was apparent.

    We therefore developed a local guideline on withholding feeds, and included a “colour chart” to help with identification of bile-stained vomit or gastric aspirates.2

    Although the primary intention was to ensure that feeds were not withheld in the smallest infants, a secondary intention was to remind others that bilious vomiting requires a careful assessment of the infant and careful consideration of an intestinal obstruction (especially malrotation) as a potential aetiology.

    However, when it came to labelling colours, it was a considerable challenge to name the colours we had chosen—one person's “forest” was another's “grass.” It was not until we settled on the tried and true method of naming bodily secretions by their resemblance to food—for example, “mustard” and “spinach”—that we all knew what each of us meant.


    • Competing interests None declared.


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