Neonatal outcomes associated with intestinal abnormalities diagnosed by fetal ultrasound

Abstract

Purpose Intestinal abnormalities are sometimes seen during antenatal testing, however the postnatal importance of these findings has not been well established. We evaluated whether abnormal intestinal appearance on fetal ultrasound (US) was ultimately related to neonatal outcome. Methods Fetal US exams from 2003–2006 were evaluated. Hyperechogenic bowel was defined as having the echogenicity comparable to bone, and dilated bowel was identified based on the sonographer’s assessment. Persistence or resolution of US findings on subsequent US exams and eventual outcomes were assessed. Cases were categorized as hyperechogenic or dilated, and then sub-grouped based on whether or not the US finding resolved. Results Sixty-eight fetuses had either hyperechogenic (n=48) or dilated bowel (n=20) on antenatal US. In 56 cases, complete data were available for analysis. Of 44 liveborn infants, 11 (25.0%) had an abdominal abnormality and 33 (75.0%) were normal at birth. Compared to those with dilated bowel, fetuses with hyperechogenic bowel had a higher rate of prenatal demise (20.8% vs 10%) but a lower rate of abnormality at birth (10.3% vs 53.3%). Hyperechogenic bowel resolved on subsequent US more frequently than dilated bowel (65.5% vs 20.0%). In both groups, all fetuses with sonographic resolution were normal at birth. Three of 9 fetuses (33.3%) that had persistently hyperechogenic bowel were born with an abnormality and all were found to have meconium peritonitis or meconium ileus. In the 12 cases where dilated bowel did not resolve, 8 (66.7%) were eventually born with an abnormality, most commonly intestinal atresia. Conclusions Hyperechogenic and dilated bowel are associated with a significant rate of fetal demise. Hyperechogenicity is more common than dilation and is more likely to be transient. Dilated bowel is more often associated with neonatal abnormality than hyperechogenic bowel. Persistence of fetal ultrasound findings predicts a higher likelihood of abnormality in the neonate.

Jejunoileal atresia: Factors affecting the outcome and long-term sequelae

“…Prenatal US findings suggestive of a JIA[8] (hypercogenic bowel, dilated fetal loops, polyhydramnios) were frequent in our series, but had no impact on the outcome. Patients with a PND had a lower median BW and GA. Possible misuse of Cesarean section in prenatally detected cases born in hospitals, without co-located surgical facilities, has been frequently reported, and the negative impact on the outcome of maturity and respiratory status has been hypothesized.…”

Diagnostic Accuracy of Prenatal Ultrasound in Identifying Jejunal and Ileal Atresia

“…While the prenatal diagnosis of duodenal atresia is highly accurate due to the pathognomonic ultrasound sign of the double-bubble, the literature has reported a sensitivity of prenatal ultrasound in the detection of small bowel atresia ranging from 23% up to 87% [8,9,10,11,12,13]. Jejunal atresia usually has higher sensitivity reaching 90% in some series [12].…”

Dilated fetal bowel as indication for prenatal diagnosis of cystic fibrosis

“…Other prenatal US signs suggestive of CF are hiperechogenic bowel, echogenic masses or pseudocysts, ascites and intraperitoneal calcifications. Ruiz et al 2 evaluated neonatal outcome of abnormal intestinal appearance on fetal US and found that of 9 fetuses with persistent hyperechogenic bowel, 33.3% had meconium peritonitis or meconium ileus, and in 12 cases of prenatal dilated bowel, 66.7% born with an abnormality, most commonly intestinal atresia.…”