Introduction Neonatal bilious vomiting is a surgical emergency until proved otherwise, and requires prompt investigation. Health workers who are unfamiliar with the colour of bile may over or under-diagnose the presence of bile in vomit or gastric aspirates.

Objective The aim of this study was to assess whether the neonatal staff in a district general hospital, where the exposure to newborns with bilious vomiting is less frequent than in a tertiary hospital, are able to identify the colour of bile accurately.

Design A total of 163 participants of both parents and health workers were asked to identify bile colour from a colour-chart of 8 green/yellow colour options. Standard chart.

Setting At Paediatric Department in Yeovil District Hospital from the first of April, 2013 to the end of July, 2013.

The results showed that the colour of bile was correctly identified by 95.5% of medical staff, 91% of nurses, midwives 72% and only 16.5% of parents. Whereas 16% of doctors, 30.5% of nurses, midwives 28% and 34% of parents wrongly identified the yellow colours as being that of bile. Our results are not significantly different from reports of similar studies done in tertiary neonatal units.

Conclusion Failure to recognize the colour of bile by health workers continues despite of using the standard colour charts at neonatal units. We suggest checking the colour by 2 professionals to reduce the possibility of incorrect recognition of bile.