Li Hongxing,Tang Weibing.Clinical characteristics of gastrointestinal malformations during neonatal period and discussion on early diagnostic methods[J].Journal of Clinical Pediatric Surgery,,21():820-826.[doi:10.3760/cma.j.cn101785-202205033-005]
Clinical characteristics of gastrointestinal malformations during neonatal period and discussion on early diagnostic methods
- Abstract:
- Objective To explore effective early detection methods, promote the early diagnosis and intervention of gastrointestinal malformations and improve the prognosis through examining the major clinical features of gastrointestinal malformations during neonatal period.Methods From January 2019 to December 2021, complete clinical data were retrospectively reviewed for 507 neonates with surgically confirmed gastrointestinal malformations. Gender, age at admission, time of symptom onset, birth weight, length of hospital stay, composition and major symptoms and accuracy of preoperative examinations were recorded. There were anorectal malformation (n=166), intestinal atresia & stricture (n=93), congenital hypertrophic pyloric stenosis (n=84), intestinal malrotation (n=72), annular pancreas (43 cases), gastrointestinal tract duplication (n=11), enteric neuropathies (n=11), congenital gastric wall muscle defect (n=9), umbilical intestinal fistula (n=7), meconium peritonitis (n=7), Meckel’s diverticulum (n=2), and congenital mesenteric malformation (n=2). There were 376 boys and 131 girls with a birth weight of (3 157.53±596.50) g. And 433 of them were full-term. A total of 139 cases were collected by measuring the distance from blind rectal end to anal recess on abdominal upside down lateral radiograph. The other 27 cases were not included in the statistics due to the lack of measurement data of the original imaging results. Receiver operating characteristic curve (ROC) analysis of perineal anoplasty (n=76) and colostomy groups (n=63) was performed.Results The median age of admission was 2.0(1.0, 8.0) days after birth, the median time to first symptoms 1.0(1.0, 4.5) days after birth and the median length of hospital stay 13.0(8.0, 19.0) days. Anorectal malformation, intestinal atresia & strictureand congenital hypertrophic pyloric stenosis were the most common digestive tract malformations in the neonatal period. The major clinical manifestations were vomiting (311/507, 61.34%), abdominal distension (239/507, 47.14%) and abnormal meconium (159/507, 31.36%). Preoperative radiographic examination was positive in 479 cases with an overall positive rate of 94.48%, abdominal ultrasound positive in 186 cases with a positive rate of 36.69% and prenatal ultrasound abnormal in 116 cases with a positive rate of 22.88%. ROC analysis showed that the distance from blind rectal end to anal recess had guiding significance for selecting surgical approaches. The accuracy rate was 73.2% and the optimal threshold 20.5 mm with a sensitivity of 74.6% and a specificity of 64.5%.Conclusion Onset time and clinical manifestations of different congenital gastrointestinal malformations have their unique characteristics.Major clinical manifestations include vomiting, abdominal distension and abnormal meconium.Radiography has a high accuracy.And prenatal and postpartum B-ultrasound are vital for an early diagnosis of gastrointestinal malformations.The popularization and application of B-ultrasound is recommended for an early diagnosis of gastrointestinal malformations.
References:
[1] Leite M, Albieri V, Kjaer SK, et al.Maternal smoking in pregnancy and risk for congenital malformations:results of a Danish register-based cohort study[J].Acta Obstet Gynecol Scand, 2014, 93(8):825-834.DOI:10.1111/aogs.12433.
[2] 杨雨溪, 黄凯坤, 刘瑞霞, 等.先天性消化道畸形的病因及诊断研究进展[J].中国医刊, 2022, 57(4):371-374.DOI:10.3969/j.issn.1008-1070.2022.04.007. Yang YX, Huang KK, Liu RX, et al.Research advances in etiology and diagnosis of congenital malformations of digestive tract[J].Chinese Journal of Medicine, 2022, 57(4):371-374.DOI:10.3969/j.issn.1008-1070.2022.04.007.
[3] 龚恩美, 张恒, 郑瑞, 等.小儿先天性消化道畸形的临床特征及手术效果[J].中国妇幼健康研究, 2019, 30(12):1587-1591.DOI:10.3969/j.issn.1673-5293.2019.12.022. Gong EM, Zhang H, Zheng R, et al.Clinical characteristics and surgical outcomes of congenital digestive tract malformation in children[J].Chinese Journal of Woman and Child Health Research, 2019, 30(12):1587-1591.DOI:10.3969/j.issn.1673-5293.2019.12.022.
[4] Zheng Z, Xie G, Yang T, et al.Congenital malformations are associated with secondhand smoke among nonsmoking women:A Meta-analysis[J].Birth, 2019, 46(2):222-233.DOI:10.1111/birt.12401.
[5] 吴少君, 万玉娟, 郭丽侠.189例新生儿消化道畸形临床分析[J].结直肠肛门外科, 2020, 26(S1):81, 93.DOI:10.19668/j.cnki.issn1674-0491.2020.S1.0074. Wu SJ, Wan YJ, Guo LX.Clinical analysis of 189 cases of neonatal digestive tract malformation[J].Journal of Colorectal & Anal Surgery, 2020, 26(S1):81, 93.DOI:10.19668/j.cnki.issn1674-0491.2020.S1.0074.
[6] 邹婵娟, 李碧香, 王友洁, 等.先天性消化道畸形142例临床特征分析[J].中国新生儿科杂志, 2014, 29(4):255-258.DOI:10.3969/j.issn.1673-6710.2014.04.010. Zhou CJ, Li BX, Wang YJ, et al.Clinical characteristics of congenital digestive tract malformations:a report of 142 cases[J].Chinese Journal of Neonatology, 2014, 29(4):255-258.DOI:10.3969/j.issn.1673-6710.2014.04.010.
[7] Ludwig K, De Bartolo D, Salerno A, et al.Congenital anomalies of the tubular gastrointestinal tract[J].Pathologica, 2022, 114(1):40-54.DOI:10.32074/1591-951X-553.
[8] Li J, Gao W, Liu X, et al.Clinical characteristics, prognosis, and its risk factors of anorectal malformations:a retrospective study of 332 cases in Anhui Province of China[J].J Matern Fetal Neonatal Med, 2020, 33(4):547-552.DOI:10.1080/14767058.2018.1497596.
[9] Maya-Enero S, Prat-Ortells J, Martín-Solé O, et al.Distinguishing outcomes of neonatal intestinal volvulus:Review of our experience over the last 20 years[J].Acta Paediatr, 2022, 111(2):284-290.DOI:10.1111/apa.16167.
[10] 吕冬梅, 张英杰, 刘鑫春, 等.X线在新生儿消化道畸形诊断中的应用研究[J].中国医药指南, 2015, 13(9):174-175.DOI:10.15912/j.cnki.gocm.2015.09.134. Lyu DM, Zhang YJ, Liu XC, et al.Application of radiography in the diagnosis of neonatal gastrointestinal malformation[J].Guide of China Medicine, 2015, 13(9):174-175.DOI:10.15912/j.cnki.gocm.2015.09.134.
[11] 林紫晴, 成宇璐, 罗慧, 等.床边超声对新生儿先天性消化道畸形的诊断价值[J].中国实用医药, 2020, 15(10):59-61.DOI:10.14163/j.cnki.11-5547/r.2020.10.024. Lin ZQ, Cheng YL, Luo H, et al.Diagnostic value of bedside ultrasound in neonatal congenital gastrointestinal malformations[J].China Practical Medicine, 2020, 15(10):59-61.DOI:10.14163/j.cnki.11-5547/r.2020.10.024.
[12] Glosser LD, Lombardi CV, Knauss HM, et al.Case report of congenital intestinal malrotation in an adult discovered three months status-post appendectomy[J].Int J Surg Case Rep, 2022, 91:106795.DOI:10.1016/j.ijscr.2022.106795.
[13] Hameed S, Caro-Domínguez P, Daneman A, et al.The role of sonography in differentiating congenital intrinsic duodenal anomalies from midgut malrotation:emphasizing the new signs of duodenal and gastric wall thickening and hyperechogenicity[J].Pediatr Radiol, 2020, 50(5):673-683.DOI:10.1007/s00247-020-04616-1.
[14] Hosokawa T, Tanami Y, Sato Y, et al.The diagnostic accuracy of ultrasound and upper gastrointestinal contrast studies for locating atresia/stenosis and intestinal malrotation and detecting annular pancreas in pediatric patients with duodenal atresia/stenosis[J].J Med Ultrason (2001), 2022, 49(2):299-309.DOI:10.1007/s10396-021-01176-1.
[15] Leiroz R, Aquino MA, Santos KP, et al.Accuracy of the mid-trimester ultrasound scan in the detection of fetal congenital anomalies in a reference center in northeastern Brazil[J].J Gynecol Obstet Hum Reprod, 2021, 50(10):102225.DOI:10.1016/j.jogoh.2021.102225.
[16] 中华医学会小儿外科学分会新生儿外科学组.常见胎儿结构畸形产前咨询儿外科专家共识J].中华小儿外科杂志, 2020, 41(12):1057-1068.DOI:10.3760/cma.j.cn421158-20200228-00126. Neonatal Surgery Group, Branch of Pediatric Surgery, Chinese Medical Association:Pediatric Surgical Expert Consensus on Prenatal Consultation for Common Fetal Structural Abnormalities[J].Chin J Pediatr Surg, 2020, 41(12):1057-1068.DOI:10.3760/cma.j.cn421158-20200228-00126.
Memo
收稿日期:2022-05-10。
基金项目:国家自然科学基金面上项目（81870372）
通讯作者:唐维兵,E-mail:twbcn@njmu.edu.cn