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Echogenic bowel in intrauterine growth restriction fetuses: does this jeopardize the gut?
Reuwen Achiron1, Rami Mazkereth, Raoul Orvieto
1Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel. rachiron@post.tau.ac.il
Insights
Fetal echogenic bowel in fetuses with intrauterine growth restriction (IUGR) does not increase the risk of necrotizing enterocolitis. These IUGR fetuses show vasodilatation in the superior mesenteric artery and celiac trunk.
Area of Science:
- Perinatal Medicine
- Neonatal Surgery
- Fetal Medicine
Background:
- Intrauterine growth restriction (IUGR) is a significant concern in high-risk pregnancies.
- Echogenic bowel and umbilical artery high resistance are potential indicators of fetal compromise.
- Neonatal necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in newborns.
Purpose of the Study:
- To determine if IUGR fetuses with echogenic bowel and high umbilical artery resistance are at increased risk for NEC.
- To investigate fetal vascular changes in IUGR fetuses with specific sonographic findings.
Main Methods:
- Comparison of two groups: singleton IUGR fetuses (echogenic bowel or reversed diastolic flow) and neonates diagnosed with NEC.
- Doppler velocimetry of the superior mesenteric artery and celiac trunk in IUGR fetuses.
- Retrospective analysis of medical records for neonates with NEC.
Main Results:
- None of the IUGR fetuses with echogenic bowel developed NEC.
- The mean birth weight was significantly lower in the IUGR group compared to the NEC group.
- IUGR fetuses demonstrated significantly lower pulsatility indices in the superior mesenteric artery and celiac trunk, indicating vasodilatation.
Conclusions:
- Fetal echogenic bowel in IUGR fetuses is not associated with an increased risk of developing NEC.
- IUGR fetuses with echogenic bowel exhibit vasodilatation in the superior mesenteric artery and celiac trunk.
- These findings suggest a different pathophysiological pathway than previously assumed for NEC development in IUGR.
Objective:
To investigate the association between intrauterine growth restriction (IUGR) fetuses with echogenic bowel and high resistance in the umbilical artery and increased risk of developing neonatal necrotizing enterocolitis.
Methods:
We analyzed two groups: group 1, singleton IUGR fetuses with echogenic bowel or reversed diastolic flow in the umbilical artery, and group 2, neonates who were diagnosed as having neonatal necrotizing enterocolitis. In group 1, the pulsatility index of the superior mesenteric artery and celiac trunk were determined. In group 2, a retrospective analysis was carried out from the medical records of the neonates.
Results:
Fifteen fetuses with echogenic bowel and severe IUGR were evaluated by Doppler studies, and 21 neonates with neonatal necrotizing enterocolitis were reviewed. In group 1, none of the IUGR fetuses developed neonatal necrotizing enterocolitis, whereas in group 2, only one neonate was defined as IUGR. The mean gestational age at delivery did not differ statistically between the two groups (28.8 +/- 2.3 weeks versus 30.1 +/- 3.3 weeks), whereas the mean birth weight was significantly lower in the first group (700 +/- 200 g versus 1431 +/- 466 g in the second group, P <.001). The mean pulsatility index +/- standard deviation in the superior mesenteric artery and celiac trunk of the IUGR fetuses were 1.5 +/- 0.14 and 1.2 +/- 0.17, respectively, both being found significantly lower than those of normal, appropriate controls (1.9 +/- 0.15 and 1.7 +/- 0.1, respectively, P <.005).
Conclusion:
Fetal echogenic bowel in IUGR fetuses is not associated with development of neonatal necrotizing enterocolitis. In these fetuses, vasodilatation in the superior mesenteric artery and celiac trunk have been demonstrated.