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Updated: May 1, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Is routine preoperative screening echocardiogram indicated in all children with congenital duodenal obstruction?
Scott S Short1, James R Pierce, Rita V Burke
1Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS# 100, Los Angeles, CA, 90027, USA.
Insights
In infants with duodenal obstruction (DO), a thorough clinical evaluation including physical exam and chest X-ray can identify those without significant congenital heart disease (CHD), potentially avoiding echocardiogram delays.
Area of Science:
- Pediatric Surgery
- Cardiology
- Neonatology
Background:
- Congenital duodenal obstruction (DO) frequently co-occurs with congenital heart disease (CHD).
- Preoperative echocardiograms for DO repair can cause significant delays.
- This study investigates if selected DO patients can safely forgo this preoperative screening.
Purpose of the Study:
- To identify and characterize CHD in infants with DO.
- To determine if specific clinical criteria can predict the absence of significant CHD.
- To assess the feasibility of foregoing routine preoperative echocardiograms in low-risk DO patients.
Main Methods:
- Retrospective review of 67 infants with DO who underwent operative repair and echocardiograms (2003-2011).
- Data collected included demographics, comorbidities, clinical findings, physical exam, and imaging.
- Analysis focused on the correlation between clinical presentation and presence of CHD.
Main Results:
- 47 (70.1%) infants had CHD; 19 (40.5%) had significant CHD.
- No asymptomatic infants without clinical findings, physical exam abnormalities, or abnormal chest X-ray had significant CHD.
- Clinical assessment, pulse oximetry, and chest X-ray demonstrated high sensitivity for excluding significant CHD.
Conclusions:
- A careful clinical assessment, including pulse oximetry and chest X-ray, may suffice to rule out significant CHD in infants with DO.
- Identifying low-risk infants can prevent unnecessary echocardiogram delays and reduce healthcare costs.
- This approach could streamline surgical care for infants with duodenal obstruction.
Introduction:
Congenital duodenal obstruction (DO) is frequently associated with congenital heart disease (CHD). Operative repair of DO is often postponed until an echocardiogram is completed, which may result in unnecessary delays. We aimed to identify and characterize CHD in children with DO to determine if appropriately selected patients could forego preoperative echocardiogram.
Methods:
A two-center retrospective review of all infants with DO undergoing operative repair with completed echocardiograms was included (2003-2011). Demographics, co-morbid conditions, clinical exam findings, radiologic imaging, and need for cardiac surgery were recorded.
Results:
67 children were identified. 47 (70.1%) had CHD on echocardiogram of which 19 (40.5%) had significant CHD. Children without clinical findings, abnormalities on physical examination, and/or abnormal chest x-ray were unlikely to have CHD; i.e., no asymptomatic child had significant CHD. Sensitivity and specificity of clinical findings, physical exam, and/or chest x-ray for significant CHD were 100% (95% CI 0.79-1.0) and 37.5% (95% CI 0.24-0.53), respectively, for major CHD and 87.2% (0.74-0.95) and 60% (0.36-0.80) for any CHD.
Conclusion:
Careful clinical assessment, evaluation with pulse oximetry, and chest x-ray may be sufficient to exclude significant CHD in children with DO. Identifying children at low risk for cardiac lesions may prevent unnecessary delays to operative intervention and may limit medical expenses.
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