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Congenital Jejunal and Ileal Atresia

Natural Prenatal Sonographic History and Association With Neonatal Outcome

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (J.R.W., A.C., M.G.P., J.B.), and Division of Pediatric Surgery, Department of Surgery (T.H., J.D.), Maine Medical Center, Portland, Maine USA.

Address correspondence to Joseph R. Wax, MD, MMC Ob/Gyn Associates, 887 Congress St, Suite 200, Portland, ME 04102 USA. E-mail: waxj{at}mmc.org

Objective. The purpose of this study was to describe the prenatal sonographic features and natural course of congenital jejunal and ileal atresia and correlate the findings with neonatal outcomes. Methods. We identified all neonates with surgically confirmed jejunal or ileal atresia that had prenatal sonography and neonatal surgery in our center from January 1, 1995, to April 1, 2005. Sonography reports and images were reviewed, without knowledge of neonatal outcomes, for features of intestinal obstruction. Obstetric and neonatal outcomes were evaluated. Results. Fifteen (60%) of 25 offspring with atresias (10 jejunal, 4 ileal, and 1 jejunoileal) had sonography, of which 13 (86.6%) had features of atresia. Findings, number of affected fetuses, and gestational age at recognition included fetal echogenic bowel (n = 8), mean ± SD, 21.3 ± 3.8 weeks (range, 17.7–28.4 weeks); enlarged stomach (n = 5), 27.5 ± 5.0 weeks (range, 22.0–34.3 weeks); dilated bowel (n = 13), 27.8 ± 5.8 weeks (range, 18.3–35.9 weeks); and polyhydramnios (n = 6), 33.3 ± 1.7 weeks (range, 31.0–35.6 weeks). No fetus with ileal atresia had an enlarged stomach or polyhydramnios. Delivery occurred at a mean of 34.7 ± 3.6 weeks, with 9 (60%) cesarean deliveries. Neonatal outcomes of age at surgery, neonatal intensive care unit days, hospital days, total parenteral nutrition days, and death were similar whether or not fetal echogenic bowel, enlarged stomach, dilated bowel, or polyhydramnios was present. Likewise, these outcomes did not vary by type of atresia or time of diagnosis (prenatal or neonatal). Conclusions. Jejunal and ileal atresia have specific sonographic patterns allowing specific prenatal diagnoses in most affected fetuses. Prenatal sonographic findings and time of diagnosis did not affect neonatal outcome.

Key Words: congenital bowel obstruction • ileal atresia • jejunal atresia • sonography

Abbreviations: FEB, fetal echogenic bowel • NICU, neonatal intensive care unit • TPN, total parenteral nutrition

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