Our results support the suspicion that a large proportion of term neonates presenting with NEC have long segment or total colonic Hirschsprung's disease. This observation is in contrast to the currently available literature on this problem from the last decade.
Fetal uropathies can be identified by obstetric ultrasound (US) examination, permitting treatment before their clinical manifestation. To evaluate the justification for prenatal US screening for urinary-tract malformations (UTM), the outcome of occult UTMs in 23,000 babies born in our hospital between 1992 and 1998 was examined retrospectively. A prenatal US examination was performed on 19,400 newborns; 128 (0.7%) had an abnormal urinary tract, leading to surgery in 38 cases. The overall incidence of UTMs requiring either medical or surgical therapy was 0.2% (45:19,400); 3,600 pregnancies were not screened by prenatal US. To date, 7 of the newborns have presented with urosepsis (2 with renal impairment) and 2 additional case of posterior urethral valves were identified by routine postnatal US. The incidence of significant UTMs was similar in both groups, but complications occurred in the unscreened group. Prenatal US to detect occult UTMs is thus beneficial, fulfilling the criteria for a population-screening test. We recommend postnatal US urinary-tract screening for newborns with no prenatal US examination.
The length of the stricture is not a problem in CPE. Our results are encouraging on the use of CPE as an alternative to esophageal replacement. We suggest using CPE even for an entire scarred esophagus. A postoperative leak due to a long suture line can be overcome by fundoplication and supportive therapy.
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