Small intestinal atresia: effect on fetal nutrition
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1Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Amniotic fluid plays a vital role in fetal nutrition, particularly in the final weeks of pregnancy. Small intestinal atresia (IA) studies show impaired fetal growth when amniotic fluid intake is disrupted.
Area of Science:
- Fetal Development
- Neonatal Surgery
- Gastroenterology
Background:
- Peak fetal weight gain occurs late in gestation.
- Fetal swallowing and absorption of amniotic fluid increase with maturation.
- The nutritive role of amniotic fluid in human fetal development is not fully understood.
Purpose of the Study:
- To investigate the nutritive role of amniotic fluid in human fetal development.
- To determine the gestational stage at which amniotic fluid significantly contributes to fetal nutrition.
- To assess the impact of small intestinal atresia (IA) on fetal growth.
Main Methods:
- Retrospective study of 59 newborns with small intestinal atresia (IA) over 9 years.
- Analysis of gestational age, birth weight, and location of IA (jejunal vs. ileal).
- Comparison of birth weights for gestational age, particularly in cases born after 36 weeks.
Main Results:
- Patients with IA born after 36 weeks' gestation showed a higher incidence of being underweight.
- Underweight incidence was higher in jejunal atresia (41.7%) compared to ileal atresia (26.7%) in this group.
- These findings suggest amniotic fluid contributes to fetal growth in late gestation, with greater impact from higher intestinal obstructions.
Conclusions:
- Amniotic fluid appears to contribute significantly to fetal growth during the last weeks of gestation.
- The severity of fetal malnutrition correlates with the level of intestinal obstruction.
- This highlights the importance of amniotic fluid's nutritive role in late-term fetal development.
Abstract:
The peak velocity for fetal weight gain occurs in the last few weeks of pregnancy. As the fetus matures, it swallows and absorbs an increasing amount of amniotic fluid, which contributes to the growth of the fetus. The authors studied cases of small intestinal atresia (IA) treated over 9 years to determine whether amniotic fluid has any nutritive role in the development of human fetus, and if it does, at what stage of gestation is the contribution of amniotic fluid significant to fetal nutrition. Fifty-nine newborns had IA (24 jejunal, 35 ileal). Ten of the patients had associated anomalies (3 cystic fibrosis, 2 congenital heart disease, 1 neural tube defect, 1 microcephaly, 2 malrotation, 1 vesicoureteric reflux). Among the 24 babies with jejunal atresia, one was a twin, and birth weight was not recorded for another. These two patients were excluded from the study. Of the remaining 22 patients with jejunal atresia, 10 were born before 36 weeks' gestation; only five of 35 patients with ileal atresia were born before 36 weeks' gestation. Fourteen patients were below the 10th percentile for birth weight after correction for gestational age, one was born before 36 weeks, and 13 were born after 36 weeks. Five (41.7%) of the 12 patients with jejunal atresia who were born after 36 weeks' gestation were underweight, as were eight (26.7%) of the 30 patients with ileal atresia. Thus, it appears that amniotic fluid contributes to the fetal growth in the last few weeks of gestation, and the higher the obstruction in the small intestine, the more pronounced the effect on the nutrition of the fetus.