The role of routine post-natal abdominal ultrasound for newborns in a resource-poor setting: a longitudinal study

Abstract

Background-Neonatal abdominal ultrasound is usually performed in Nigeria to investigate neonatal symptoms rather than as a follow up to evaluate fetal abnormalities which were detected on prenatal ultrasound. The role of routine obstetric ultrasonography in the monitoring of pregnancy and identification of fetal malformations has partly contributed to lowering of fetal mortality rates. In Nigeria which has a high maternal and fetal mortality rate, many pregnant women do not have ante-natal care and not infrequently, women also deliver their babies at home and only bring the newborns to the clinics for immunization. Even when performed, most routine obstetric scans are not targeted towards the detection of fetal abnormalities.The aim of the present study is to evaluate the benefit of routinely performing abdominal scans on newborns with a view to detecting possible abnormalities which may have been missed ante-natally.Methods-This was a longitudinal study of 202 consecutive, apparently normal newborns. Routine clinical examination and abdominal ultrasound scans were performed on the babies by their mother's bedside, before discharge. Neonates with abnormal initial scans had follow-up scans.Results-There were 108 males and 94 females. There were 12 (5.9%) abnormal scans seen in five male and seven female neonates. Eleven of the twelve abnormalities were in the kidneys, six on the left and five on the right. Three of the four major renal anomalies- absent kidney, ectopic/pelvic kidney and two cases of severe hydronephrosis were however on the left side. There was one suprarenal abnormality on the right suspected to be a possible infected adrenal haemorrage. Nine of the abnormal cases reported for follow- up and of these, two cases had persistent severe abnormalities.Conclusions-This study demonstrated a 5.9% incidence of genito urinary anomalies on routine neonatal abdominal ultrasound in this small population. Routine obstetric USS is very useful but inadequate availability of skilled personnel and cost implications create great challenges in poor resource settings like Nigeria. However, awareness should be created so that parents who can afford such investigations can make informed decisions.

Near infrared spectroscopy and abdominal compartmental syndrome in neonates

“…Cerebral (C) sensor positioned on the forehead (below the hairline) and a renal (R) sensor on the neonate's lower back (right side) between T10 and L2, accurate localization of right kidney performed using ultrasound curvilinear transducer with a frequency ranging between 5 and 7.5 MHz. [17] All infants had general anesthesia induced by incremental concentrations of sevoflurane (2%-4%) with oxygen and 24 gauge intravenous cannula was inserted and secured.…”

Types and Outcome of Fetal Urinary Anomalies in Low Resource Setting Countries: A Retrospective Study

“…The role of the prenatal ultrasound has evolved in its specificity (93-99 %) and sensitivity (14-85 %) for identification of fetal malformations and has partly contributed to the lowering of fetal mortality rates [7,8]. More abnormalities are seen by the third trimester, and a single early scan may miss some fetal anomalies [9]. We performed a retrospective analysis of 41 cases of kidney and urinary tract anomalies diagnosed by antenatal ultrasound during the last 3 years in the Department of Obstetrics and Gynecology, Mansoura University Hospital, Egypt.…”

Ultrasound Use in Resource-limited Settings: A Systematic Review

“…Given poor access to antenatal care and screening in resource poor countries, Agunloye et al conducted a study in Nigeria to evaluate the role of routine abdominal US scans in newborns, with the goal of detecting possible abnormalities which may have been missed antenatally (6). They found a 5.9% incidence of genitourinary abnormalities, primarily affecting the kidneys, suggesting that there is some benefit to routine pre-and post-natal screening.…”

“…They found a 5.9% incidence of genitourinary abnormalities, primarily affecting the kidneys, suggesting that there is some benefit to routine pre-and post-natal screening. While Nigeria has a high maternal and fetal mortality rate and could benefit significantly from routine US screening, investigators identified cost of equipment and lack of skilled personnel as major barriers to implementing this technology (6).…”

“…Several studies cite cost as a major barrier, particularly the machine itself, maintenance, gel, Internet access for educational resources, expert advice and consultation, as well as expenses associated with training personnel (6,9,11,12,17,20,27,34,36,55). Lack of formal US training programs appears to be another major barrier, with several studies reporting a significant need for experts to implement and teach such programs (6,9,12,20,27,43,54,55). As mentioned prior, if a remote web-based program is implemented, there are typically high costs associated with computer and Internet access for educational materials and consultation.…”