Obligation of ultrasound examination of the abdominal organs in newborns for the timely establishment of the diagnosis and reduction of postoperative mortality

Surgical diseases of the abdominal cavity of the neonatal period manifest similar symptoms, but require a different treatment strategy. In most cases, when conducting special sonographic studies, there are signs of the cause of the symptoms.

Purpose: to create and estimate surgical tactics depending on the revealed sonographic signs of gastrointestinal pathology in newborns.

Methods: were examined sonographically 1557 newborns with symptoms of congenital intestinal obstruction (CIO), hypertrophic pyloric stenosis (HPS), necrotizing enterocolitis, meconium obstruction, functional disorders (FD) of the GIT: vomiting, abdomen distention, absent meconium. The surgeon’s tactics were created depending on the revealed sonographic signs. Two groups of operated patients were compared: 1st (n = 55) used special ultrasound methods for initial assessment of the newborn, 2nd (n = 44) ultrasound was not performed. The groups the timeliness of diagnosis and postoperative lethality were estimated.

Results: in 86.0% of newborns, symptoms were associated with FD. All types of surgical pathology of the GIT had sonographic signs. According to the ultrasound, the next situations were identified: surgery without further investigations (volvulus, peritonitis); additional examinations are needed to clarify the diagnosis (CIO); additional investigations are not required (HPS, FD). In the 1st group, the diagnosis was significantly more often made in time, less lethality was observed than in patients of the 2nd group (p <0.001; p <0.026, respectively).

Conclusion: sonographic signs during the initial examination of a newborn with symptoms of acute diseases or congenital defects of GIT contribute to the timely diagnosis and allow to determine further tactics of investigation and treatment.

1. Isakov YU.F., Dronov A. F. Detskaya khirurgiya: natsional’noye rukovodstvo [Pediatric surgery: National guidelance]. Moscow, Medicina: GEOTAR-Media, 2009. 168 p. (in Russ).

2. Holcomb G.W., Murphy P. J. Ashcraft’s pediatric surgery. Ostlie – 6th Ed., Elsevier Inc., 2014. 1192 р.

3. Glasser J. G. Intestinal obstruction in the newborn. Available at: http://emedicine.medscape.com/article/2066380‑overview (accessed Mar 17 2016).

4. Dimmitt R. A., Moss R. L. Meconium diseases in infants with very low birth weight. Semin. Pediatr. Surg. 2000; 9: 79–83.

5. Keeney S. E., Angel C. A., Thompson L. L., et al. Meconium obstruction in the very low birth weight premature infant. J. Pediatrics. 2004; 114: 285–290.

6. Verma A., Rattan K. N., Yadav R. Neonatal intestinal obstruction: A 15 year experience in a Tertiary care hospital. J. Clin. Diagn. Res. 2016; 10 (2): 10–13. doi: 10.7860/JCDR/2016/17204.7268.

7. Allin B., Long A., Gupta A., et al. A UK wide cohort study describing management and outcomes for infants with surgical Necrotising Enterocolitis. Sci. Rep. 2017; 7: 41149. doi: 10.1038/srep41149.

8. Srinivas S., Reddy K. R., Balraj T. A., et al. Neonatal small bowel obstruction due to malrotation: a clinical study. Int Surg J. 2017; 4 (8): 2727–2729. DOI: 10.18203/2349–2902.isj20173107.

9. Yanitskaya M. Yu., Sapozhnikov V. G., Poddubnyi I. V. Diagnostics and treatment of newborn intestinal obstruction with use of methods of interventional ultrasound. Experimental and Clinical Gastroenterology, 2019, No. 171, pp. 64–71. DOI: 10.31146/1682–8658‑ecg‑171–11–64–71 (in Russ).

10. Olkhova E. B. Options for echographic representation of Ledd’s syndrome in newborns. Pediatric Surgery, 2013, No. 5, pp. 16–20. (in Russ).

11. Epelman M., Daneman A., Navarro O. M., et al. Necrotizing Enterocolitis: Review of State-ofthe-Art Imaging Findings with Pathologic Correlation. RadioGraphics. 2007; 2: 285–305.

12. Pykov M. I. Detskaya ul’trazvukovaya diagnostika. [Children’s ultrasound diagnostics]. Moscow, Vidar, 2015. 680 p.

13. Dvoryakovsky I.V., Sugak A. B. Ul’trazvukovaya diagnostika pri sindrome srygivaniya i rvoty u novorozhdonnykh i detey grudnogo vozrasta [Ultrasound diagnostics for regurgitation and vomiting syndrome in newborns and infants]. Ultrasound and Functional Diagnostics, 2007, no. 1, pp. 84–92 (in Russ).

14. Walker G.M., Neilson A., Young D., et al. Colour of bile vomiting in intestinal obstruction in the newborn: questionnaire study. BMJ. 7554(332): 1363. doi:10.1136/bmj.38859.614352.55.

15. Kimura K., Loening-Baucke V. Bilious vomiting in the newborn: Rapid diagnosis of intestinal obstruction. J. Am. Fam. Physician. 2000; 61: 2791–2798.

16. Alexander K.M., Chan, S.S., Opfer E., et al. Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis. Arch. Dis. Child. Fetal. Neonatal. 2020. DOI: 10.1136/archdischild‑2019–318382.

17. Trunova T. Yu., Razin M. P., Ershkova M. M., et al. Features of necrotizing enterocolitis in newborns in the departments of the second stage of nursing. Medical Newsletter of Vyatka, 2019;2(66): 31–35 (in Russ).

18. Penco J. M.M., Murillo J. C., Hernandez A., et al. Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age. Pediatr. Surg. Int. 2007; 19: 544–547. doi: 10.1007/s00383–007–1972–0.

19. Grona V. N., Zhurilo I. P., Perunsky V. P., et al. Narusheniya fiksatsii i rotatsii kishechnika u novorozhdonnykh [Disorders of fixation and rotation of the intestine in newborns]. Clinical Anatomy and Surgery, 2007, no.. 6., pp. 29–33 (in Russ).

20. Gilbertson-Dahdal D.L., Dutta S., Varich L. J., et al. Neonatal malrotation with midgut volvulus mimicking duodenal atresia. AJR Am. J. Roentgenol. 2009; 192: 1269–1271. doi: 10.2214/AJR.08.2132.

21. Mehall J.R., Chandler J. C., Mehall R. L., et al. Management of typical and atypical intestinal malrotation. J Pediatr. Surg. 2002; 37: 1169–1172.