Related Experiment Videos
Fetal echogenic gut: a marker of intrauterine gut ischaemia?
A K Ewer1, J M McHugo, S Chapman
1Birmingham Maternity Hospital.
Insights
Fetal echogenic gut (FEG) in fetuses with intrauterine growth retardation (IUGR) is associated with significant gastrointestinal feeding problems after birth. Infants with FEG experienced delayed feeding tolerance and required more interventions compared to controls.
Area of Science:
- Perinatology
- Neonatology
- Pediatric Gastroenterology
Background:
- The clinical significance of fetal echogenic gut (FEG) remains largely unknown.
- Intrauterine growth retardation (IUGR) with absent umbilical artery end-diastolic flow velocities is a high-risk condition.
- FEG may indicate underlying fetal gastrointestinal dysfunction.
Purpose of the Study:
- To prospectively evaluate the gastrointestinal (GI) function in infants with FEG and IUGR.
- To compare feeding outcomes in infants with and without FEG.
Main Methods:
- A prospective study of nine infants with FEG and IUGR and absent umbilical artery end-diastolic flow velocities.
- A control group of nine infants with IUGR and absent umbilical artery end-diastolic flow velocities but without FEG.
- Postnatal evaluation of gastrointestinal function, including feeding tolerance and need for interventions.
Main Results:
- All infants in the FEG group developed significant abdominal distension, large bile-stained aspirates, and constipation requiring interventions.
- Enteral feeding was discontinued in the FEG group due to feeding intolerance.
- Median time to tolerate full enteral feeds was significantly longer in the FEG group (15 days) compared to controls (4 days).
- A higher proportion of infants in the FEG group required parenteral nutrition.
Conclusions:
- FEG in fetuses with IUGR and absent umbilical artery end-diastolic flow velocities is predictive of significant postnatal gastrointestinal feeding problems.
- Anticipation of feeding difficulties is crucial when FEG is detected prenatally.
- Further research into the pathophysiology of FEG is warranted.
Abstract:
The pathophysiological significance of fetal echogenic gut (FEG) is unknown. Our aim was prospectively to evaluate FEG in infants with intrauterine growth retardation (IUGR) and absent umbilical artery end diastolic flow velocities. Over a 15 month period, nine infants with FEG met these criteria. Nine infants who, on antenatal assessment, had demonstrated IURG and absent umbilical artery end diastolic flow velocities, but no evidence of FEG, were selected as case-controls. Gastrointestinal function was then prospectively evaluated in both groups after delivery. All liveborn infants received nasogastric feeds of breast milk by 8 days of age. All in the FEG group developed marked abdominal distension, large, bile stained, nasogastric aspirates, and constipation requiring rectal washouts. This led to a discontinuation of enteral feeds on one or more occasions. Two patients in the FEG group required water soluble contrast enemas in order to relieve intestinal obstruction. In the control group, 3/9 patients had abdominal distension, but no rectal washouts were given and enteral feeds were not interrupted. The median (range) time to tolerate full enteral feeds was 15 (7-32) days in the FEG group, compared with 4 (1-8) days in the control group. In the FEG group 5/6 patients required parenteral nutrition for 5-27 days. In the control group one patient required parenteral nutrition over a period of four days only. No child had necrotising enterocolitis or cystic fibrosis. When FEG is observed in the fetus with IUGR, problems with enteral feeding should be anticipated.