Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Pediatr Surg. 2023 Jun;58(6):1090-1094. doi: 10.1016/j.jpedsurg.2023.02.029. Epub 2023 Feb 17.
The purpose of this study was to assess diagnostic accuracy and neonatal outcomes in fetuses with a suspected proximal gastrointestinal obstruction (GIO).
After IRB approval, a retrospective chart review was conducted on prenatally suspected and/or postnatally confirmed cases of proximal GIO at a tertiary care facility (2012-2022). Maternal-fetal records were queried for presence of a double bubble ± polyhydramnios, and neonatal outcomes were assessed to calculate the diagnostic accuracy of fetal sonography.
Among 56 confirmed cases, the median birthweight and gestational age at birth were 2550 g [interquartile range (IQR) 2028-3012] and 37 weeks (IQR 34-38), respectively. There was one (2%) false-positive and three (6%) false-negatives by ultrasound. Double bubble had a sensitivity, specificity, positive predictive value, and negative predictive value for proximal GIO of 85%, 98%, 98%, and 83%, respectively. Pathologies included 49 (88%) with duodenal obstruction/annular pancreas, three (5%) with malrotation, and three (5%) with jejunal atresia. The median postoperative length of stay was 27 days (IQR 19-42). Cardiac anomalies were associated with significantly higher complications (45% vs 17%, p = 0.030).
In this contemporary series, fetal sonography has high diagnostic accuracy for detecting proximal gastrointestinal obstruction. These data are informative for pediatric surgeons in prenatal counseling and preoperative discussions with families.
Diagnostic Study, Level III.
本研究旨在评估疑似近端胃肠道梗阻（GIO）胎儿的诊断准确性和新生儿结局。
在获得机构审查委员会批准后，对三级医疗机构中疑似产前和/或确诊为近端 GIO 的病例（2012-2022 年）进行了回顾性图表审查。对母婴病历进行了双泡征+羊水过多的查询，并评估了新生儿结局，以计算胎儿超声检查的诊断准确性。
在 56 例确诊病例中，中位出生体重和出生时的胎龄分别为 2550g（四分位距[IQR]2028-3012）和 37 周（IQR 34-38）。超声检查有 1 例（2%）假阳性和 3 例（6%）假阴性。双泡征对近端 GIO 的敏感性、特异性、阳性预测值和阴性预测值分别为 85%、98%、98%和 83%。病变包括 49 例（88%）十二指肠梗阻/环状胰腺、3 例（5%）旋转不良和 3 例（5%）空肠闭锁。术后中位住院时间为 27 天（IQR 19-42）。心脏畸形与更高的并发症发生率显著相关（45%比 17%，p=0.030）。
在本当代系列中，胎儿超声检查对检测近端胃肠道梗阻具有很高的诊断准确性。这些数据可为儿科外科医生提供产前咨询和与家属进行术前讨论的信息。
诊断研究，III 级。
