Gastrointestinal Issues

3 cases of antenatal intestinal perforation so far , we have entertained in our NICU. All term newborns with symptoms like abdominal distension and vomiting on day 2-3 of life, imaging done(X-ray and USG abdomen ) and revealed NEC like picture stage 3 with advance presentation . interestingly, newborn were not so sick clinically. one of them were diagnosed in antenatal period as some pseudocyst around live or pancreas through fetal MRI. Surgical interventions done and all are doing well during follow up. Biopsy of intestinal segment around perforation doesn't reveal any significant pathology.

Which one do you use in follow-up of the newborn? Fenton o Intergrowth ?

14 days old born at 27 week with birth weight 840 gms was on enteral feeds. Suddenly noted to have abdominal diatension platelets 32000 but no ither iasues. Any suggestions about xray.

As you probably know, I also work for Neobiomics - a startup company centered around a dedicated group of clinicians/academics. We would like to learn more about current use / non-use of probiotics and would love to get your feedback. If you complete the survey (takes ~2 min), we will donate 100 SEK (~10€) to Médecins Sans Frontières (MSF), UNICEF or European Foundation for the Care of Newborn Infants (EFCNI) Please note that the survey is only open for respondees based in Europe. https://forms.gle/tbS3f7RbDigT3jEL7

Check out this blog post by Keith Barrington whether transfusions trigger NEC. Or does anemia. https://neonatalresearch.org/2019/04/16/do-transfusions-trigger-nec-or-does-anemia/ I would say that there are enough clinical research data out there to say that there seems to be NO association. Just check out the PINT trial, the RCT comparing a liberal vs a restrictive Hb level for transfusion in preterm infants. If anything, the more liberally transfused group of infant had less NEC. And read this paper by Patel et al that nicely demonstrates that there seems to be confounding of indication coming into play, i.e. it is not the transfusion but the underlying anemia is t…

How to approach fetal/ neonatal ascitis with perihepatic calcification? FT , AGA, 3.8 kg born via elective cs to G1Pnow 1 didn’t need resuscitation, no distress , VS NORMAL & stable , passed urine & meconium. Systemic exam. is remarkable for abdominal enlargement, umbilical hernia & huge bilateral hydrocele . Lab WNR , imaging: abd US & CT REVEALED free fluid & peri hepatic & perisplenic calcification. Tolerated feeding . Prenatal 4D revealed isolated ascitis

I have been intrigued by 2 cases of adhesions , One in a patient operated for ileal atresia and the other with NEC. What is the pathology behind this? Does the type of intestinal surgery or any defect ( vascular , chemical , duration of surgery) affect occurence of adhesions? Is there any way to protect it during surgery ? And any ways to conservatively manage and till when surgery can be delayed? Kindly post your opinions and evidence for this.

I would like to hear about how you diagnose and manage pneumatosis intestinalis. the background - we sometimes comes across infants (mostly preterms) with some GI symtoms, like blood in stools, but without clinical signs and no lab signs towards NEC. But the xray shows some intramural gas. we usually start conservative NEC TX (fasting, antibiotics, TPN) but stop it after a few days of normal blood tests and if xray normalize. there are some Pubmed reports on this seemingly more benign phenomen but would be great to hear how you handle this.

Surfactant lavage, a therapeutic intervention used in Japan, although I have doubts about this intervention, it would be nice to know whether other NICUs out there use it. Do you use surfactant lavage in your unit? If “Yes” What are the possible indications? What surfactant/saline ratio do you use? Would you use in atelectatic changes in BPD cases suspecting thick secretions to be causing the atelectasis?

We had the discussion recently about long-term use of anti-reflux medications after esophageal atresia repair. Drugs like lansoprazol can really clogg the NG tube (like concrete!)... and from what I read in this systematic review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899117/) it seems that there is no clear benefit. Although the quality of evidence is classified as low, and that "more research is needed". Do your pediatric surgeons advocate the use of anti-reflux medications after esophageal atresia repair? If yes, for how long? If the infant needs NG tube feeding for a longer period time (like 4-8 weeks), how often do you change the NG tube? Ask…