Congenital duodenal obstruction: timing of diagnosis during the newborn period

Abstract

Objective: To determine age at diagnosis for congenital duodenal obstruction in the neonatal period and the relationship to clinical outcomes.Study Design: A children's hospital database reflecting a 7 ½-year period was reviewed to identify infants with the diagnosis of duodenal obstruction in the neonatal period. Infants were grouped according to time of diagnosis: antepartum, postpartum in-hospital or after hospital discharge. Clinical descriptors and outcome variables were assessed between infants in these three groups.Result: In total, 27/51 (53%) infants were diagnosed antenatally. Infants with prenatal diagnosis were less mature, more likely to have Down syndrome or other birth defects and the pregnancy was more likely to be complicated by polyhydramnios. Of the 24 infants diagnosed postnatally, 8 (33%) were diagnosed after hospital discharge. These infants tended to be breast fed and discharged before 48 h of age. They had greater weight loss and more metabolic disturbances at readmission for surgery. One infant in the late diagnosis group died.Conclusion: Infants with congenital duodenal obstruction, particularly if breast fed, may not present with classical findings of upper gastrointestinal obstruction in the first days of life. Careful in-hospital evaluation of infants with persistent regurgitation, even low volume, is recommended to avoid missing this diagnosis.

Congenital duodenal obstruction in the UK: a population-based study

“…Of note, a number of specialist children’s hospitals in the UK are not colocated with maternity services necessitating postnatal transfer of a newborn infant. The overall prenatal detection rate of 59% is similar to the 53% reported in a single-centre study from the USA13 and 52% from a European prenatal ultrasound population-based study 14. Consequently, in nearly half of all infants with CDO, there will be no prenatal detection.…”

Association Between Prenatal Sonographic Findings of Duodenal Obstruction and Adverse Outcomes

“…This distinguishing feature has brought about great advances in the diagnosis since the late 1970s 5 . As a result, prenatal detection rates of this anomaly have reached 50% 6 – 8 …”

“…Regarding congenital duodenal obstruction, no reported study has focused on prenatal sonographic findings, including bowel dilatation, which could aid in the prediction of adverse outcomes. Some studies, however, have reported adverse outcomes in duodenal obstruction according to the presence of an associated anomaly, chromosomal abnormality, or the time of diagnosis 8 , 18 – 20 …”

Factors Affecting Early Mortality and Morbidity in Congenital Duodenal Obstruction: Summary of a 20-Year Experience

“…All such cases are generally considered to be CDOs; both internal and external causes of CDO have been defined [9]. The ultrasonographic rate of prenatal CDO diagnosis is 16-53% [8,10]. We attribute the low rate of such diagnosis in our study to technical deficiencies and physician inexperience.…”