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Kassif E, Weissbach T, Shust‐Barequet S, Raviv O, Snenh SA, Avraham E, Cahan T, Koren N, Yulzari V, Hadi E, Adamo L, Revivo M, Tovi SM, Achiron R, Kivilevitch Z, Weisz B, Weissmann‐Brenner A. The fetal stomach throughout gestation: Normal charts and clinical implication. Prenat Diagn 2021. [DOI: 10.1002/pd.5990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Eran Kassif
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Tal Weissbach
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shir Shust‐Barequet
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Oshrat Raviv
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Samar Abu Snenh
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Efrat Avraham
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Tal Cahan
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Natalie Koren
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Vered Yulzari
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Efrat Hadi
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Laura Adamo
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Department of Obstetrics and Gynecology IRCCS Fondazione Policlinico San Matteo University of Pavia Pavia Italy
| | - Marva Revivo
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shalev Mazaki Tovi
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Reuven Achiron
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Zvika Kivilevitch
- Women's Ultrasound Unit Maccabi Health Services Negev Medical Center Beer‐Sheva Israel
| | - Boaz Weisz
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Alina Weissmann‐Brenner
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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Toscano M, Burhans K, Mack LM, Henderson S, Koltz PF, Girotto JA, Thornburg LL. Prenatal Ultrasound Measurement of Fetal Stomach Size Is Predictive of Postnatal Development of GERD in Isolated Cleft Lip and/or Palate. Cleft Palate Craniofac J 2020; 58:881-887. [PMID: 33153316 DOI: 10.1177/1055665620968717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether prenatal ultrasound measurement of fetal stomach size, as a surrogate marker of fetal swallowing, is predictive of postnatal development of gastroesophageal reflux disease (GERD) in cases of isolated cleft lip and/or palate (CL/P). DESIGN This is a retrospective case-control study. The outcome of interest is postnatal diagnosis of GERD in isolated CL/P. The exposure of interest is prenatal stomach size measurement by ultrasound. SETTING The study population was selected from an academic, tertiary care center between 2003 and 2011. PATIENTS/PARTICIPANTS Cases were neonates undergoing CL/P repair during the study period. Cases with other known structural or chromosomal abnormalities were excluded. Controls were contemporary, nondiabetic neonates that matched gestational age (within one week) to cases. Each case measurement was matched ∼1:2 with control measurement. INTERVENTIONS None. MAIN OUTCOME MEASURE The primary outcome was difference in mean prenatal ultrasound measurement of fetal stomach size between cases and controls. We hypothesized that patients with postnatal development of GERD would have smaller mean fetal stomach size. RESULTS There were 32 cases including 19 patients with unilateral cleft lip and palate, 8 with unilateral cleft lip, and 4 with bilateral cleft lip and palate. Cases were noted to have smaller mean anterior-posterior and transverse fetal stomach measurements as compared to controls. This was statistically significant from 16 to 21 weeks, 25 to 27 weeks, and 28 to 36 weeks (P < .01 for all). CONCLUSIONS Prenatal ultrasound measurement of fetal stomach size as a surrogate marker of fetal swallowing is predictive of postnatal development of GERD in isolated CL/P.
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Affiliation(s)
- Marika Toscano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Kristen Burhans
- Department of Obstetrics and Gynecology, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Lauren M Mack
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 3989Baylor College of Medicine, Houston, TX, USA
| | | | - Peter F Koltz
- St. Luke's Hospital, Maumee, Ohio, USA.,St. Anne's Hospital, Toledo, Ohio, USA
| | - John A Girotto
- Spectrum Health Medical Group, Grand Rapids, MI, USA.,24319Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Loralei L Thornburg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 6923University of Rochester Medical Center, Rochester, NY, USA
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Bergman NJ. Neonatal stomach volume and physiology suggest feeding at 1-h intervals. Acta Paediatr 2013; 102:773-7. [PMID: 23662739 DOI: 10.1111/apa.12291] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/05/2013] [Accepted: 05/07/2013] [Indexed: 01/14/2023]
Abstract
UNLABELLED There is insufficient evidence on optimal neonatal feeding intervals, with a wide range of practices. The stomach capacity could determine feeding frequency. A literature search was conducted for studies reporting volumes or dimensions of stomach capacity before or after birth. Six articles were found, suggesting a stomach capacity of 20 mL at birth. CONCLUSION A stomach capacity of 20 mL translates to a feeding interval of approximately 1 h for a term neonate. This corresponds to the gastric emptying time for human milk, as well as the normal neonatal sleep cycle. Larger feeding volumes at longer intervals may therefore be stressful and the cause of spitting up, reflux and hypoglycaemia. Outcomes for low birthweight infants could possibly be improved if stress from overfeeding was avoided while supporting the development of normal gastrointestinal physiology. Cycles between feeding and sleeping at 1-h intervals likely meet the evolutionary expectations of human neonates.
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Affiliation(s)
- Nils J Bergman
- Department of Human Biology; Department of Paediatrics; University of Cape Town; Cape Town South Africa
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Hata T, Tanaka H, Noguchi J, Inubashiri E, Yanagihara T, Kondoh S. Three-dimensional sonographic volume measurement of the fetal stomach. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1808-1812. [PMID: 20888688 DOI: 10.1016/j.ultrasmedbio.2010.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 06/08/2010] [Accepted: 06/17/2010] [Indexed: 05/29/2023]
Abstract
The objective of this study was to measure the fetal gastric volume using three-dimensional (3-D) ultrasound during pregnancy. Three-dimensional sonographic examinations were performed involving 35 pregnant women from 12 to 38 weeks of gestation. The fetal gastric volume was monitored every 5 min for a minimum of 40 min (40-60 min) in each woman. The rotational technique with Virtual Organ Computer-aided AnaLysis (VOCAL) was used to calculate the fetal gastric volume. Maximum and minimum gastric volumes were curvilinearly associated with the gestational age, respectively (R(2) = 0.611, p < 0.0001, and R(2) = 0.407, p < 0.0001, respectively). A curvilinear relationship was noted between the functional capacity (maximum volume - minimum volume) of the fetal stomach and gestational age (R(2) = 0.531, p < 0.0001). The maximum volume change [(maximum volume - minimum volume/maximum volume) × 100] did not change during pregnancy (mean and standard deviation, 64.1% ± 16.1%). However, gastric emptying cycles could not be determined in this study because of the short observation period and small number of subjects. Our findings suggest that the fetal gastric volume calculated by conventional two-dimensional ultrasound in previous investigations is approximately one-third of the maximum volume using 3-D ultrasound in the present study and that 3-D ultrasound is a superior means of evaluating the fetal gastric volume in utero. However, the data and their interpretation in the present study should be viewed with some degree of caution because of the small number of subjects. Further studies involving a larger sample size are needed to confirm these findings.
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Affiliation(s)
- Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, Miki, Kagawa, Japan.
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Emami CN, Petrosyan M, Giuliani S, Williams M, Hunter C, Prasadarao NV, Ford HR. Role of the host defense system and intestinal microbial flora in the pathogenesis of necrotizing enterocolitis. Surg Infect (Larchmt) 2010; 10:407-17. [PMID: 19943775 DOI: 10.1089/sur.2009.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is a devastating disease that affects primarily the intestine of premature infants. Despite recent advances in neonatology, NEC remains a major cause of morbidity and mortality in neonates. Neonatal mucosal defenses and adherence of bacterial pathogens may play an important role in the pathogenesis of NEC. METHODS Review and synthesis of pertinent literature. RESULTS Putative factors that have been implicated in the pathogenesis of NEC include abnormal patterns of gut colonization by bacteria, immaturity of the host immune system and mucosal defense mechanisms, intestinal ischemia, formula feeding, and loss of intestinal epithelial barrier integrity. CONCLUSION Host defenses and intestinal microbial ecology are believed to play important roles in the pathogenesis of NEC. Commensal bacteria and probiotic therapy may be of therapeutic utility in the maintenance of the gut epithelial barrier.
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Affiliation(s)
- Claudia N Emami
- Department of Surgery, Childrens Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California 90027, USA
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Axer H, Bernstein HG, Keiner S, Heronimus P, Sauer H, Witte OW, Bogerts B, Bär KJ. Increased neuronal cell number in the dorsal motor nucleus of the vagus in schizophrenia. Acta Neuropsychiatr 2010; 22:26-34. [PMID: 25384954 DOI: 10.1111/j.1601-5215.2009.00434.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Axer H, Bernstein H-G, Keiner S, Heronimus P, Sauer H, Witte OW, Bogerts B, Bär K-J. Increased neuronal cell number in the dorsal motor nucleus of the vagus in schizophrenia. OBJECTIVE Recently, a reduction in efferent vagal regulation has been found in schizophrenic patients. METHODS Therefore, the brainstems of nine schizophrenic patients and nine normal controls were stereologically analysed. The number of neurons using the optical fractionator method and nuclear volumes applying the Cavalieri principle was estimated in Nissl stained sections of the dorsal motor nucleus of the vagus (DMNV) and the hypoglossal nucleus. RESULTS The neurons in the right DMNV were significantly increased in the schizophrenic group compared to normal controls (p = 0.047), while the volumes of the DMNV did not differ. In contrast, no such differences were found in the hypoglossal nucleus. CONCLUSION Although this pilot study is limited by its small sample size, the analysis of the solitarius-ambiguus-vagus system in schizophrenic patients is an interesting target in schizophrenia research. The most reasonable background for increased neuron numbers in the DMNV could be a system-specific neurodevelopmental disturbance in schizophrenia.
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Affiliation(s)
- Hubertus Axer
- 1Department of Neurology, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07747 Jena, Germany
| | - Hans-Gert Bernstein
- 2Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Silke Keiner
- 1Department of Neurology, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07747 Jena, Germany
| | - Polina Heronimus
- 2Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Heinrich Sauer
- 3Department of Psychiatry and Psychotherapy, Friedrich-Schiller-University Jena, Philosophenweg 3, D-07747 Jena, Germany
| | - Otto W Witte
- 1Department of Neurology, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07747 Jena, Germany
| | - Bernhard Bogerts
- 2Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Karl-Jürgen Bär
- 3Department of Psychiatry and Psychotherapy, Friedrich-Schiller-University Jena, Philosophenweg 3, D-07747 Jena, Germany
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Hyett J. Intra-abdominal masses: prenatal differential diagnosis and management. Prenat Diagn 2008; 28:645-55. [DOI: 10.1002/pd.2028] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schnabl KL, Aerde JEV, Thomson ABR, Clandinin MT. Necrotizing enterocolitis: A multifactorial disease with no cure. World J Gastroenterol 2008; 14:2142-61. [PMID: 18407587 PMCID: PMC2703838 DOI: 10.3748/wjg.14.2142] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Necrotizing enterocolitis is an inflammatory bowel disease of neonates with significant morbidity and mortality in preterm infants. Due to the multifactorial nature of the disease and limitations in disease models, early diagnosis remains challenging and the pathogenesis elusive. Although preterm birth, hypoxic-ischemic events, formula feeding, and abnormal bacteria colonization are established risk factors, the role of genetics and vasoactive/inflammatory mediators is unclear. Consequently, treatments do not target the specific underlying disease processes and are symptomatic and surgically invasive. Breast-feeding is the most effective preventative measure. Recent advances in the prevention of necrotizing enterocolitis have focused on bioactive nutrients and trophic factors in human milk. Development of new disease models including the aspect of prematurity that consistently predisposes neonates to the disease with multiple risk factors will improve our understanding of the pathogenesis and lead to discovery of innovative therapeutics.
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Lin PW, Nasr TR, Stoll BJ. Necrotizing enterocolitis: recent scientific advances in pathophysiology and prevention. Semin Perinatol 2008; 32:70-82. [PMID: 18346530 DOI: 10.1053/j.semperi.2008.01.004] [Citation(s) in RCA: 200] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality among infants in the neonatal intensive care unit. Here we review the epidemiology and pathophysiology of NEC, with an emphasis on the latest research findings and potential areas for future research. NEC continues to be one of the most devastating and unpredictable diseases affecting premature infants. Despite decades of research, the pathogenesis of this disease remains unclear, and prevention and treatment strategies are limited. Hopefully, future studies aimed at understanding premature intestinal defenses, commensal or probiotic bacterial influences, and possible genetic predisposition will lead to the improvement of prevention and treatment strategies.
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Affiliation(s)
- Patricia W Lin
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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Abstract
In necrotizing enterocolitis (NEC) the small (most often distal) and/or large bowel becomes injured, develops intramural air, and may progress to frank necrosis with perforation. Even with early, aggressive treatment, the progression of necrosis, which is highly characteristic of NEC, can lead to sepsis and death. This article reviews the current scientific knowledge related to the etiology and pathogenesis of NEC and discusses some possible preventive measures.
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Cheng G, Zhu H, Zhou X, Qu J, Ashwell KWS, Paxinos G. Development of the human dorsal nucleus of the vagus. Early Hum Dev 2008; 84:15-27. [PMID: 17376613 DOI: 10.1016/j.earlhumdev.2007.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 12/01/2006] [Accepted: 01/01/2007] [Indexed: 10/23/2022]
Abstract
The dorsal nucleus of the vagus nerve plays an integral part in the control of visceral function. The aim of the present study was to correlate structural and chemical changes in the developing nucleus with available data concerning functional maturation of human viscera and reflexes. The fetal development (ages 9 to 26 weeks) of the human dorsal nucleus of the vagus nerve has been examined with the aid of Nissl staining and immunocytochemistry for calbindin and tyrosine hydroxylase. By 13 weeks, the dorsal vagal nucleus emerges as a distinct structure with at least two subnuclei visible in Nissl stained preparations. By 15 weeks, three subnuclei (dorsal intermediate, centrointermediate and ventrointermediate) were clearly discernible at the open medulla level with caudal and caudointermediate subnuclei visible at the level of the area postrema. All subnuclei known to exist in the adult were visible by 21 weeks and cytoarchitectonic differentiation of the nucleus was largely completed by 25 weeks. The adult distribution pattern of calbindin and tyrosine hydroxylase immunoreactive neurons was also largely completed by 21 weeks, although morphological differentiation of labeled neurons continued until the last age examined (26 weeks). The structural development of the dorsal nucleus of the vagus nerve appears to occur in parallel with functional maturation of the cardiovascular and gastric movements, which the nucleus controls.
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Affiliation(s)
- Gang Cheng
- Prince of Wales Medical Research Institute, Barker St Randwick, NSW, Australia.
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Abstract
Necrotising enterocolitis is one of the most common gastrointestinal emergencies in newborn infants. Here we review the epidemiology, clinical presentation, and pathophysiology of the disease, as well as strategies for diagnosis, management, and prevention. Necrotising enterocolitis is one of the most devastating and unpredictable diseases affecting premature infants. Despite decades of research, its pathogenesis remains unclear; diagnosis can be difficult; and treatment is challenging. We will need to improve our understanding of intestinal defences in premature infants, dietary and bacterial factors, and genetic effects that could predispose infants to necrotising enterocolitis before we can develop new strategies for prevention and treatment.
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Affiliation(s)
- Patricia W Lin
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
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