Preliminary Investigation of the Diagnosis of Neonatal Congenital Small Bowel Atresia by Ultrasound

Cellular senescence as a key contributor to secondary neurodegeneration in traumatic brain injury and stroke

Traumatic brain injury (TBI) and stroke pose major health challenges, impacting millions of individuals globally. Once considered solely acute events, these neurological conditions are now recognized as enduring pathological processes with long-term consequences, including an increased susceptibility to neurodegeneration. However, effective strategies to counteract their devastating consequences are still lacking. Cellular senescence, marked by irreversible cell-cycle arrest, is emerging as a crucial factor in various neurodegenerative diseases. Recent research further reveals that cellular senescence may be a potential driver for secondary neurodegeneration following brain injury. Herein, we synthesize emerging evidence that TBI and stroke drive the accumulation of senescent cells in the brain. The rationale for targeting senescent cells as a therapeutic approach to combat neurodegeneration following TBI/stroke is outlined. From a translational perspective, we emphasize current knowledge and future directions of senolytic therapy for these neurological conditions.

Point-of-care abdominal ultrasound in pediatric and neonatal intensive care units

A spectrum of critical abdominal pathological conditions that might occur in neonates and children warrants real-time point-of-care abdominal ultrasound (abdominal POCUS) assessment. Abdominal radiographs have limited value with low sensitivity and specificity in many cases and have no value in assessing abdominal organ perfusion and microcirculation (Rehan et al. in Clin Pediatr (Phila) 38(11):637-643, 1999). The advantages of abdominal POCUS include that it is non-invasive, easily available, can provide information in real-time, and can guide therapeutic intervention (such as paracentesis and urinary bladder catheterization), making it a crucial tool for use in pediatric and neonatal abdominal emergencies (Martínez Biarge et al. in J Perinat Med 32(2):190-194, 2004) and (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021).  Conclusion: Abdominal POCUS is a dynamic assessment with many ultrasound markers of gut injury by two dimensions (2-D) and color Doppler (CD) compared to the abdominal X-ray; the current evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency situations. However, it should still be considered an adjunct rather than replacing abdominal X-rays due to its limitations and operator constraints (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). What is Known: • Ultrasound is an important modality for the assessment of abdominal pathologies. What is New: • The evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency abdominal situations in the neonatal and pediatric intensive care units.

Diagnostic value of the microcolon using ultrasonography in small bowel atresia

Background

Microcolon helps diagnose small bowel atresia (SBA) using contrast enema. However, there are no ultrasonography (US) microcolon criteria for diagnosing SBA. Therefore, this study aimed to evaluate colon accuracy and other characteristics for diagnosing SBA by US, using surgical or clinical information as the reference standard.

Methods

US was performed on 46 neonates aged ≤ 7 days old. In the study group (n = 15), neonates with SBA were confirmed following surgery. In the study group without SBA (n = 15), neonates with other gastrointestinal problems besides SBA were confirmed by surgical or clinical follow-up. Sixteen neonates without gastrointestinal problems were classified as the control group. The colonic diameter was measured, and colonic gas was sought and observed. Statistical analysis was performed to compare US parameters between the study group and other two groups. The optimal cut-off value of the colonic diameter for SBA diagnosis was obtained using receiver operating characteristic analysis.

Results

Colonic diameters (0.5 cm) in the study group (interquartile ranges [IQR], 0.5–0.6 cm) was significantly smaller than that in the group without SBA (0.9 cm; IQR, 0.8–1.2 cm) (P <  0.001) and in the control group (1.2 cm; IQR, 0.8–1.35 cm) (P < 0.001). Optimum cut-off value for diagnosing SBA was 0.65 cm (sensitivity, 90.3%; specificity, 86.7%; accuracy, 89.1%) for the colonic diameter. Combining microcolon and gas-negativity showed the best performance in SBA diagnosis using US, with increased accuracy (91.3%).

Conclusion

A colon < 0.65 cm in diameter should be called a microcolon; combining US with gas-negativity is an essential diagnostic basis for SBA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03629-z.

New sonographic feature (C-sign) to improve the prenatal accuracy of jejunal atresia

OBJECTIVES

To describe a new sonographic feature of the C-sign for prenatal diagnosis of jejunal atresia and evaluate its role in prenatal jejunal atresia, particularly preceding bowel dilatation and polyhydramnios.

METHODS

This was a retrospective study from a tertiary maternal hospital. Patients with prenatal sonographic examination and confirmed small bowel atresia postdelivery were included. All sonographic images were reviewed by two senior sonographers. Comparison of sonographic images between prenatal jejunal and ileal atresia using the C-sign resembles the shape of the entire duodenum and other traditional sonographic features. The control group without bowel atresia was assessed for the presence of the C-sign.

RESULTS

The C-sign and combined bowel dilatation with polyhydramnios were more frequent in jejunal atresia than ileal atresia, but the C-sign can be used to detect jejunal atresia earlier. The C-sign can be more likely to diagnose jejunal atresia in persisting bowel dilatation and polyhydramnios. The C-sign was not reported in any of the control fetuses.

CONCLUSION

The C-sign is a new sonographic feature that can be used to improve the prenatal accuracy and early detection of jejunal atresia. However, further prospective validation is needed.

Small-bowel atresias: a case series with review of the disease and imaging findings

Small-bowel atresias are among the most common causes of intestinal obstruction in newborns, and they often require urgent surgical treatment. Imaging techniques play a very important role in their diagnosis, which is often suspected on prenatal obstetric ultrasound and confirmed on postnatal plain-film X-rays. Abdominal ultrasound's lack of ionizing radiation, wide availability, low cost, and high resolution is making this technique increasingly important in confirming atresias and in detecting possible complications in newborns. This review analyzes a series of cases seen at our center. It summarizes the different types of small-bowel atresias, focusing on the clinical presentation, imaging findings on different modalities, presence of associated disease, management, clinical course, and outcomes.

Kaposiform hemangioma of jejunum in a newborn: A case report and review of literature

•

Kaposiform hemangioma is a rare tumor, of vascular origin, usually in childhood.

•

The diagnosis sometimes is made only in the intraoperative.

•

It is possible to make a differential diagnosis with congenital intestinal stenosis.

•

Surgery is consisted of resection of the stenotic area.

Introduction

Kaposiform hemangioendothelioma is a rare tumor, of vascular origin, which predominates in childhood. Although it is frequently a vascular cutaneous anomaly, it is known that some cases can involve bones, mediastinum and retroperitoneum, being even rarer when it occurs in the small intestine, representing only 0.05% of all intestinal neoplasms.

Presentation of case

Female patient, 21 days old, born at 38 weeks, is admitted to the hospital due to bilious vomiting, dehydration and major abdominal distension. An X-ray of the acute abdomen suggests type I jejunal atresia. An exploratory laparotomy was performed, with the presence of a stenotic area in the proximal jejunum, which was chosen for resection of the stenotic area and end-to-end terminal anastomosis, with post-pyloric jejunostomy. The presence of kaposiform hemangioma was confirmed by immunohistochemistry, and the patient had no further complications.

Discussion

The presence of hemangiomas in childhood is frequent, is but it very rare when it appears in the gastrointestinal location, as reported in the present case. A common presentation is intestinal bleeding, being manifested as anemia or, sometimes, acute and potentially fatal anemia. Other forms of rare presentation include intussusception, perforation and obstruction, the latter being out patient's last manifestation. The diagnosis of this alteration can be difficult, and often performed only in the intraoperative period of an exploratory laparotomy.

Conclusion

The presence of bilateral vomiting and intestinal obstruction in newborns opens the possibility of a wide range of possible diagnoses, such as the presence of intestinal atresia. Kaposiform intestinal hemangioma is an uncommon cause in these clinical manifestations, but it should be included in the differential diagnosis.