Pre-auricular tags and pits in the newborn: the role of renal ultrasonography

Pfaff M. External ear malformations and cardiac and renal anomalies: A systematic review and meta-analysis

CONTEXT

External Ear Malformations (EEM) continue to be a common malformation seen in the pediatric patient population. This study aims to further elucidate the correlation between EEM and cardiac and renal anomalies.

OBJECTIVE

A systematic review and meta-analysis to study the incidence of cardiac and renal anomalies associated with syndromic and isolated (EEM).

DATA SOURCES

The literature search spanned multiple databases, including Google Scholar, PubMed, Scopus, Web of Science, and MEDLINE.

STUDY SELECTION

Studies must be focused on EEM and cardiac and/or renal anomalies. Only articles written in English were included.

DATA EXTRACTION

General study characteristics, number of EEM patients, number of cardiac and renal anomalies and whether cases were syndromic were extracted from the studies.

RESULTS

Of 1,058 initial studies, 33 were included for meta-analyses. Mean JBI score for all included studies was 92.06%, indicating acceptable study quality. Interrater reliability was high, with a Cohen kappa score for all studies of 0.94. The resulting pooled prevalence of cardiac abnormalities was 20% [95% CI:13-28%], while renal abnormalities were 13% [95% CI: 7-20%]. The most common anomalies were VSD (3.725%) and renal agenesis (2.04%). The presence of syndrome data across studies was not a significant modifier of prevalence rates.

LIMITATIONS

Primary limitation is due to heterogeneity in individual study methodology and reporting standards.

CONCLUSIONS

These results highlight a higher prevalence of cardiac-related conditions than renal anomalies in patients with both syndromic and non-syndromic EEM in the included studies, underscoring the need for thorough clinical evaluations.

Ectopic Unilateral Ear Pit in an Otherwise Well-Appearing Child: A Case Report and Literature Review

Ear pits are a common congenital abnormality that is incidentally found on routine examinations. However, it is not well documented how many are found outside of their classical location or if these ectopic locations put patients at increased risk of having a hearing impairment, renal anomalies, genetic syndromes, or infection. Clinicians should be aware of the current guidelines for recognizing, screening, and evaluating for these risks in patients with ear pits, regardless of location.

[Antenatal ear examination: When, how and why?]

Antenatal ear examination is an integral part of the thorough examination of the fetal face. The discovery of an anomaly, whether it is made by chance or during a complementary in-depth examination, leads the practitioner to determine its isolated or associated character, in order to characterise its possible belonging to a syndromic entity. In this context, the realization of genetic analysis more precise and wider allowing a return of the results in a time compatible with an evolutive pregnancy, gives to the geneticist a central role in the management of these couples. The main challenge lies in obtaining a set of concordant clinical and biological clues, enabling the genetic results identified to be interpreted correctly, the optimised functioning of the ultrasound practitioner - geneticist duo is therefore fundamental. This results in a complex information to deliver, in the fact that the clinical translation of an ear anomaly in antenatal can go from an isolated aesthetic anomaly to a genetic syndrome with neurodevelopmental disorder. The objective of this work is to describe, from a methodological analysis of antenatal ears, the accessible malformative entities, isolated or associated, and to discuss the problems in the need or not to propose their screening.

A Single Institutional Review of Periauricular Vestiges and Renal Anomalies: The Role of Screening Renal Ultrasonography

ABSTRACT

Children with minor ear malformations including periauricular vestiges often undergo renal ultrasonography (RUS) to exclude renal anomalies associated with genetic conditions. The aim of this study is to assess the association between isolated periauricular vestiges and renal anomalies and delineate the indication for RUS in screening for renal anomalies. This is a retrospective review of infants who underwent surgical consultation for periauricular vestige excision to probe a possible relationship with renal anomalies. Patients with an isolated vestige were compared to patients presenting with additional clinical findings suggestive of a possible genetic disorder. A total of 150 infants underwent periauricular vestige excision; 47 were referred for RUS, 23 with no additional clinical findings, and 24 with periauricular vestiges in addition to other suspicious clinical and/or developmental findings. Of these 47 patients, 10 had renal anomalies: 4 (17.4%) with an isolated periauricular vestige had minor anomalies and 6 (25.0%) with a vestige plus suspicious clinical signs had 5 minor anomalies and one major anomaly. The odds of a patient with an isolated periauricular vestige having positive RUS findings were not significantly different than a patient with additional clinical findings having positive RUS findings (P = 0.72).The incidence of renal anomalies in infants with an isolated periauricular vestige was similar to that in patients with associated clinical signs suggestive of a possible genetic disorder. This was higher than the background population rate. Although most anomalies in patients with isolated ear findings were minor, our results suggest routine screening RUS should be considered.

A Review of Benign Congenital Anomalies

Benign congenital anomalies are common in neonates. Some of these common benign congenital anomalies include preauricular pits, sacral dimples, supernumerary digits, accessory nipple, and natal teeth. It is important for health care providers who take care of newborns to recognize these benign anomalies so that unnecessary evaluations and investigations are not performed. However, some of these anomalies may be associated with clinically significant conditions. In this article, we discuss when further evaluation should be performed in babies presenting with these common benign congenital anomalies. [Pediatr Ann. 2020;49(2):e66-e70.].

[Congenital cysts and fistulae in children]

Cysts and fistulae of the face and neck in children are formed before birth and correspond to the persistence of embryonic remnants that occur due to coalescence defects of embryonic buds or due to epidermal inclusion. They represent the most common pathological malformation of the face and neck. They may be separated according to their location into laterocervical cysts and fistulas or median cysts and fistulas. Their discovery may occur prematurely at birth or later during growth or in adulthood. Their treatment always requires surgical excision, which must be complete in order to prevent recurrences.

Evaluation and diagnosis of the dysmorphic infant

Neonatologists have a unique opportunity to be the first to identify abnormalities in a neonate. In this review, multiple anomalies and physical features are discussed along with the potential associated genetic syndromes. The anomalies and physical features that are discussed include birth parameters, aplasia cutis congenita, holoprosencephaly, asymmetric crying facies, preauricular ear tags and pits, cleft lip with or without cleft palate, esophageal atresia/tracheoesophageal fistula, congenital heart defects, ventral wall defects, and polydactyly.

Developmental anomalies of the skin

This paper focuses on the diagnosis and management of developmental anomalies of the skin that may be seen early in life. Common locations include the head, nose, preauricular area of the face, neck, and spine. Those that occur in or near the midline can be more serious because of possible intracranial connections. Radiologic imaging of the areas of involvement is often important; computed tomography (CT) scans can delineate bony defects; whereas, magnetic resonance imaging (MRI) more clearly defines intracranial connections. Occult spinal dysraphism can be suspected when certain cutaneous signs are present.

Isolated preauricular pits and tags: is it necessary to investigate renal abnormalities and hearing impairment?

We investigated the incidence and co-existence of hearing impairment and renal abnormalities in healthy children with preauricular tags and pits. Study population consists of 13,740 primary school children from routine health check. Thirty-five children with preauricular tags and pits were noted. Control group consisted of 91 patients without pits and tags, who underwent renal ultrasound and were scheduled to pediatric outpatient clinic. Urinalysis, renal ultrasound, otoacoustic emission were performed in both the groups. The prevalence of renal abnormality (1/36; 2.7%) and hearing impairment (1/36; 2.7%) in patients with preauricular tags and pits was similar to that of control group (3/91; 3.2% and 4/91; 4.3%) (P = 0.87, P = 0.64, respectively). According to our results, it is not necessary to investigate hearing or urinary abnormality in patients with preauricular tag or pit, unless there is an association of a syndrome or family history of hearing or renal impairment.

Association of isolated preauricular tags and nephrourological anomalies: case-control study

Isolated preauricular tags (IPT) are considered minor malformations whereas nephrourological anomalies (NUA) are considered major malformations. Their incidences fluctuate between 5 and 10 per 1,000 and 1-3 per 100 live births, respectively. There is contradictory evidence regarding the incidence of NUA in infants with IPT. The objective of this study is to determine if there is a clinical association between IPT and NUA. A case-control study was made in a Pediatric hospital in Santiago, Chile, with infants born between April 2000 and April 2005, considering as cases those with IPT, and controls those infants born following the cases, paired by sex and without IPT. All subjects had a complete physical examination and a renal ultrasound to assess for the presence of congenital anomalies and NUA, respectively. One hundred cases and an equal number of controls were included. There were 41 females in each group. In the case group, two infants presented renal anomalies in the RUS: one left hydronephrosis and one case of left kidney agenesis. In the control group, two infants with anomaly were found: one with a left ureterocele and one case of bilateral duplex kidney. The observed incidence of NUA was similar in both groups to that reported in the literature for the general population. No significant statistical difference was found in the incidence of these abnormalities between patients who presented with IPT and those who did not. From our study, we suggest that RUS is not necessary in the routine evaluation of infants with IPT.

Pediatric surgical pearls: minimizing complications

Performing dermatologic surgery in infants and children presents unique challenges. A thorough understanding of both pediatric developmental milestones and their unique surgical circumstances is essential to providing optimal dermatologic care of the pediatric patient. In this work, we combine the authors' experiences with data from the literature to provide pediatric dermatologic procedural pearls.

Renal ultrasonography not required in babies with isolated minor ear anomalies

AIM

To determine whether infants with isolated minor anomalies of the external ear are at increased risk of renal malformations.

METHODS

Consecutive infants with isolated minor anomalies of the external ear (preauricular skin tags, preauricular sinuses, ear pits, and misshapen pinnae) were offered renal ultrasonography by experienced sonographers over a 41 month period. The prevalence of renal anomalies in such infants was compared with that detected on routine fetal scanning during the same period.

RESULTS

Ninety six of 13 136 liveborn infants (7.3/1000, 95% confidence interval (CI) 5.9 to 8.9) were noted to have isolated minor ear anomalies on routine neonatal examination, with preauricular skin tags being the most common (85%). Ninety one (95%) infants underwent renal sonography at a mean (SD) age of 40 (19.6) days. Only one infant (1.1%, 95% CI 0.03 to 5.9) had transient unilateral pyelectasia. During the same period, non-syndromic renal anomalies were found in 0.64% (95% CI 0.52 to 0.73) of infants, a prevalence no different from that of infants with minor ear anomalies (p = 0.44).

CONCLUSIONS

Routine renal imaging is not warranted in infants with such minor external ear anomalies unless accompanied by other systemic malformations.

Lumps and bumps in neonates and infants

There are many developmental abnormalities that may appear in the neonate and in infants when critical steps in embryogenesis fail. These steps are often not fatal but can lead to significant morbidity for those patients affected. A logical approach is needed in addressing both the diagnostic and therapeutic issues that arise when caring for these patients, as various lesions will warrant an observational approach, and others may require imaging studies or definitive surgical intervention. Additionally, there are other "lumps and bumps" that are seen in the neonatal and infantile age groups that include malignancies and cutaneous neoplasms with associated systemic sequelae.