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BMC Gastroenterology Jul 2020Studies of microbiota composition of infants with small intestinal ostomy due to various etiologies are limited. Here, we characterized the intestinal microbiota of...
BACKGROUND
Studies of microbiota composition of infants with small intestinal ostomy due to various etiologies are limited. Here, we characterized the intestinal microbiota of neonates with ileostomy resulting from distinct primary diseases.
METHODS
Fifteen patients with necrotizing enterocolitis, eight patients with meconium peritonitis, and seven patients with Hirschsprung's disease were included in the study. The small intestinal microbiota composition in infants with ileostomy caused by these diseases was studied.
RESULTS
Microbial diversity in neonatal ileostomy fluid was generally low, and was dominated by members of the Proteobacteria and Firmicutes phyla. At the genus level, the most abundant were Klebsiella, Escherichia-Shigella, Streptococcus, Clostridium sensu stricto 1, Enterococcus, and Lactobacillus. Streptococcus and Veillonella are related to carbohydrate metabolism and immunity, and breastfeeding can increase the proportion of these potentially beneficial bacteria. The proportion of Bifidobacterium in the breastfeeding group was higher than that in the non-breastfeeding group, and incidence of colitis and sepsis was reduced in the breastfeeding group. The proportion of Bifidobacterium increased and incidence of colitis and sepsis decreased in the breastfeeding group compared with the non- breastfeeding group, but there was no significant difference. The increase in body weight in the breastfeeding group was observed to be higher than in the non-breastfeeding group.
CONCLUSIONS
Excessive Klebsiella and Escherichia-Shigella and low abundance of Streptococcus, Veillonella and Faecalibacterium suggests that the small intestinal microbiota is in an unhealthy state after ileostomy. However, Streptococcus, Faecalibacterium, and Veillonella species were frequently present, suggesting that expansion of these bacteria might assist the development of the immune system after surgery.
Topics: Bifidobacterium; Gastrointestinal Microbiome; Humans; Ileostomy; Infant; Infant, Newborn; Microbiota; Prognosis
PubMed: 32660555
DOI: 10.1186/s12876-020-01366-0 -
Frontiers in Pediatrics 2022Enteral feeding after intestinal atresia has always been a concern for clinicians. But the present studies mainly focused on single factors. This research aimed to...
OBJECTIVE
Enteral feeding after intestinal atresia has always been a concern for clinicians. But the present studies mainly focused on single factors. This research aimed to comprehensively analyze the multiple factors on complete enteral nutrition after primary anastomosis, and establish the convenient prediction model.
METHODS
We retrospectively collected reliable information in neonates with intestinal atresia form January 2010 to June 2022. The cox regression analysis was performed to select independent risk factors and develop nomogram. Subsequently, ROC curve, calibration curve and decision curve were drawn to thoroughly evaluate the accuracy and applicability of the model.
RESULTS
The predictors finally included in the model were gestational age, meconium peritonitis, distance from the anastomosis to the ileocecal region, diameter ratio of proximal to distal bowels, and time of initial feeding. The nomogram of predicting the probability of week 2, week 3 and week 4 was drawn and their area under the curve were 0.765, 0.785 and 0.747, respectively. Similarly, calibration and decision curve indicated that the prediction model had a great prediction performance.
CONCLUSION
The clinical value of predictive models can be recognized. The hope is that the predictive model can help pediatricians reduce hospital costs and parental anxiety.
PubMed: 36578664
DOI: 10.3389/fped.2022.1071056 -
International Journal of Surgery Case... Jul 2023Segmental absence of the muscularis propria intestinalis (SAIM) is a rare pathology characterized by a partial or complete absence of the intestinal musculature....
INTRODUCTION AND IMPORTANCE
Segmental absence of the muscularis propria intestinalis (SAIM) is a rare pathology characterized by a partial or complete absence of the intestinal musculature. Diagnosis requires histological confirmation, and treatment includes urgent laparotomy, resection of affected areas, and end-to-end anastomosis or creation of stomas. The work has been reported in line with the SCARE guideline criteria.
CASE REPORT
We present the case of a 31-week preterm newborn with prenatal diagnosis of polyhydramnios and non-immune fetal ascites. Radiological tests confirmed meconium peritonitis, and laparotomy was indicated. The patient had a torpid postoperative course requiring multiple surgeries due to intestinal occlusion and leakage of the anastomosis. Finally, he was discharged with good oral tolerance and bowel function. The anatomopathological examination reported the congenital absence of intestinal muscle with segmental and multifocal distribution.
CLINICAL DISCUSSION
Most neonatal cases share similar clinical features, and if SAIM is suspected during surgery, the suspicious areas should be resected to prevent future complications. The prognosis depends on the extent of the lesion, possibility of resecting affected segments, and concomitant pathologies.
CONCLUSION
In conclusion, this study aims to describe SAIM based on a clinical case and review of the literature. SAIM is a rare pathology that requires prompt diagnosis and treatment to prevent complications. Surgeons should consider resecting suspicious areas during surgery to prevent future complications.
PubMed: 37390581
DOI: 10.1016/j.ijscr.2023.108424 -
Wavy Floating Greater Omentum Findings Are Useful for Differentiating the Etiology of Fetal Ascites.Diagnostics (Basel, Switzerland) Feb 2021The greater omentum is an apron-like peritoneal mesothelial sheet that was described by ultrasound as a floating fluid-filled viscus in ascites during the fetal period....
The greater omentum is an apron-like peritoneal mesothelial sheet that was described by ultrasound as a floating fluid-filled viscus in ascites during the fetal period. To examine the association between the etiology of fetal ascites and ultrasound findings of the greater omentum, a retrospective study was conducted. Ultrasound findings of fetal omentum were defined as follows: (1) a cyst-like shape with a thin membrane observed as wavy in the ascites, (2) beside the stomach and below the liver, and (3) no blood flow noted on color Doppler. Eleven pregnancies had fetal ascites. A fetal greater omentum was confirmed in eight cases in which ascites were caused by non-peritonitis: fetal hydrops ( = 4), congenital cytomegalovirus infection ( = 2), idiopathic chylous ascites ( = 1), and unknown cause ( = 1). Of these eight cases, no abdominal surgical management was required in three live babies. However, a fetal greater omentum was not confirmed in all three cases of meconium peritonitis. It was suggested that the finding of the greater omentum can be an important clue for estimating the pathophysiological etiology of fetal ascites and helping with postnatal management. It should be reasonable to add the finding of the greater omentum to the detailed ultrasound examination checklist.
PubMed: 33671226
DOI: 10.3390/diagnostics11020326 -
Journal of Medical Ultrasound 2019Hydrops fetalis in association with meconium peritonitis is a rare condition, and the mechanism underlying hydropic changes has not been fully recognized. We present a...
Hydrops fetalis in association with meconium peritonitis is a rare condition, and the mechanism underlying hydropic changes has not been fully recognized. We present a case of fetal meconium peritonitis with hydrops and coagulopathy. Clinically, the cause of fetal disseminated intravascular coagulation is considered to be a consequence of a systematic inflammatory response based on progressive, but mild fetal anemia without other apparent triggers, thrombocytopenia, elevated white blood cell count and serum C reactive-protein, hypoalbuminemia, and increased vascular permeability. The infant was born at 32 weeks of gestation and survived after postnatal multidisciplinary treatment. Our experience suggests that recognition of this rare condition will enable early diagnosis and better clinical management for fetuses with meconium peritonitis.
PubMed: 31867196
DOI: 10.4103/JMU.JMU_25_19 -
Yonago Acta Medica Nov 2023In recent years, the number of neonatal surgeries has been on the rise despite the decline in the number of births, and we examined the actual trends and problems at...
BACKGROUND
In recent years, the number of neonatal surgeries has been on the rise despite the decline in the number of births, and we examined the actual trends and problems at Tottori University Hospital located in the Sanin region.
METHODS
Medical records were retrospectively searched for patients who underwent major surgery during the neonatal period (within 30 days of age) at the Tottori University Hospital over the past 10 years (Jan. 2011 to Dec. 2020).
RESULTS
Sixty-five cases were included. Early birth infants (< 37 gestational weeks) comprised 15 cases (23%) and low birth weight (< 2500 g) infants involved 27 cases (42%). In the latter half (2016-2020), early birth and low birth weight infants were significantly less than in the first half (2011-2015). The common diseases were anorectal malformation (14 cases), esophageal atresia (10), duodenal atresia (10), and diaphragmatic hernia (9). Prenatal diagnosis was obtained in 26 cases (40%), with high diagnostic rate obtained in duodenal atresia (100%), abdominal wall defect (100%), ileal atresia (75%), meconium peritonitis (67%), and diaphragmatic hernia (67%). Fifty-five cases (85%) were operated on within 7 days of age. Other major malformations were associated in 23 cases (35%). There were 6 deaths (9%), of which 3 cases were low birth weight infants with gastrointestinal perforation, 2 cases with severe chromosomal abnormalities (esophageal atresia, omphalocele), and 1 case with diaphragmatic hernia with severe pulmonary hypertension. Home medical care has been required with gastrostomy tube in 2 cases.
CONCLUSION
Neonatal surgery at Tottori University has been well performed as required with acceptable results along with the progression of other perinatal care. However, further investigation for improvements in premature delivery or organ hypoplasia may be required.
PubMed: 38028267
DOI: 10.33160/yam.2023.11.003 -
Clinical Case Reports Aug 2022We present a case report of a fetal diagnosis of cystic fibrosis after ultrasound abnormalities. After delivery, a type 3A intestinal atresia was diagnosed. Segmental...
We present a case report of a fetal diagnosis of cystic fibrosis after ultrasound abnormalities. After delivery, a type 3A intestinal atresia was diagnosed. Segmental enterectomy with end-to-end anastomosis was performed. This case report highlights the diagnosis complexity of a fetal intestinal atresia associated with cystic fibrosis.
PubMed: 35949411
DOI: 10.1002/ccr3.5869 -
Cureus Jan 2023A meconium pseudocyst is formed following meconium peritonitis. At present, antenatal diagnosis and planned management of meconium pseudocyst have reduced the mortality...
A meconium pseudocyst is formed following meconium peritonitis. At present, antenatal diagnosis and planned management of meconium pseudocyst have reduced the mortality rate significantly. We presented a case of a neonate with abdominal distension and non-passage of meconium who experienced respiratory distress and was taken for exploratory laparotomy at a tertiary care center due to suspected bowel perforation. The neonate was diagnosed with a meconium pseudocyst intraoperatively as maternal ultrasound and ultrasound of the abdomen of the neonate after birth failed to make a definitive diagnosis; even an X-ray abdomen did not reveal pathognomonic egg-shell calcification. An interesting aspect of this case is the mother's complex obstetric history, which compelled us to conjecture whether it was possible to predict the chances of meconium peritonitis and take steps to prevent it. It must be noted that, despite rigorous research, the researchers could not find reliable literature co-relating the obstetric history of the mother with the formation of a meconium pseudocyst in the neonate.
PubMed: 36788879
DOI: 10.7759/cureus.33625 -
Journal of Indian Association of... 2022Gastrointestinal (GI) malformations have varied short-term and long-term outcomes reported across various neonatal units in India.
BACKGROUND
Gastrointestinal (GI) malformations have varied short-term and long-term outcomes reported across various neonatal units in India.
METHODS
This descriptive study was done to study the clinical profile, outcomes and predictors of mortality in neonates operated for congenital GI malformations in a tertiary neonatal care unit in South India between years 2011 and 2020. Details were collected by retrospective review of the case sheets.
RESULTS
Total of 68 neonates were included with esophageal atresia (EA) in 10, infantile hypertrophic pyloric stenosis (IHPS) in 9, duodenal atresia (DA) in 10, ileal atresia in 8, jejunal atresia in 5, anorectal malformations (ARM) in 11, meconium ileus/peritonitis in 9, malrotation in 2, and Hirschsprung's disease (HD) in 4. Antenatal diagnosis was highest in DA (80%). Associated anomalies were maximum in EA (50%), the most common being vertebral, anal atresia, cardiac defects, tracheoesophageal fistula, renal and radial abnormalities, and limb abnormalities association (VACTERL). Overall mortality was 15%. IHPS, DA, Malrotation, HD and ARM had 100 % survival while ileal atresia had the least survival (38%). Gestational age <32 weeks (odds ratio [OR] 12.77 [1.96, 82.89]) and outborn babies (OR 5.55 [1.01, 30.33]) were significant predictors of mortality in babies operated for small intestinal anomalies. None of the surviving infants were moderately or severely underweight at follow-up.
CONCLUSION
Overall survival of surgically correctable GI anomalies is good. Among the predictors for mortality, modifiable factors such as in-utero referral of antenatally diagnosed congenital anomalies need attention. One-fifth had associated anomalies highlighting the need to actively look for the same. Although these neonates are vulnerable for growth failure, they had optimal growth on follow-up possibly due to standardized total parenteral nutritional policy during neonatal intensive care unit stay.
PubMed: 35733590
DOI: 10.4103/jiaps.JIAPS_10_21 -
BMC Pediatrics Dec 2019In the last century, meconium peritonitis(MP)was once a highly fatal gastrointestinal. disease With the development of fetal radiological technology, abnormal signs,...
BACKGROUND
In the last century, meconium peritonitis(MP)was once a highly fatal gastrointestinal. disease With the development of fetal radiological technology, abnormal signs, such as pseudocysts, can. be detected during the fetal period so that more patients can be diagnosed prenatally and receive surgery. in the early stage of life. The survival rate of MP has increased up to 80% in recent years. According to. a review of the treatment and outcomes of patients diagnosed with MP, we evaluated the influence of. early operation on survival rate and discussed the risk factors of prognosis.
METHODS
We collected 79 cases of patients diagnosed with MP who were treated in our department. from October 2001 to December 2017. They were divided into 2 groups. Patients in group A were born. in our hospital. Patients in group B were born in a local hospital with suspicion of MP and then transferred. to our department.
RESULTS
The birth weight (BW) and gestational age (GA) of patients were higher in group A than in. group B. There was no significant difference in the proportion of premature and low birth weight (LBW). patients between the two groups (p = 0.422, p = 0.970). Their age at the time of surgery was younger in. group A than in group B (1.4 ± 2.0 vs. 6.9 ± 14.9, p < 0.001). The overall survival rate of group A was higher. than that of group B (95.0% vs. 79.5%, p = 0.038). The prognosis of premature patients was worse than. that of full-term infants for both groups (p = 0.012).
CONCLUSIONS
Prematurity is a significant risk factor related to death for MP patients. The survival rate. of MP patients can be improved by early operation during the neonatal period.
Topics: Female; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Perforation; Magnetic Resonance Imaging; Male; Meconium; Peritonitis; Prenatal Diagnosis; Prognosis; Retrospective Studies; Survival Rate; Time-to-Treatment; Ultrasonography, Prenatal
PubMed: 31795969
DOI: 10.1186/s12887-019-1844-5