Obligation of ultrasound examination of the abdominal organs in newborns for the timely establishment of the diagnosis and reduction of postoperative mortality

Abstract

Surgical diseases of the abdominal cavity of the neonatal period manifest similar symptoms, but require a different treatment strategy. In most cases, when conducting special sonographic studies, there are signs of the cause of the symptoms.Purpose: to create and estimate surgical tactics depending on the revealed sonographic signs of gastrointestinal pathology in newborns.Methods: were examined sonographically 1557 newborns with symptoms of congenital intestinal obstruction (CIO), hypertrophic pyloric stenosis (HPS), necrotizing enterocolitis, meconium obstruction, functional disorders (FD) of the GIT: vomiting, abdomen distention, absent meconium. The surgeon’s tactics were created depending on the revealed sonographic signs. Two groups of operated patients were compared: 1st (n = 55) used special ultrasound methods for initial assessment of the newborn, 2nd (n = 44) ultrasound was not performed. The groups the timeliness of diagnosis and postoperative lethality were estimated.Results: in 86.0% of newborns, symptoms were associated with FD. All types of surgical pathology of the GIT had sonographic signs. According to the ultrasound, the next situations were identified: surgery without further investigations (volvulus, peritonitis); additional examinations are needed to clarify the diagnosis (CIO); additional investigations are not required (HPS, FD). In the 1st group, the diagnosis was significantly more often made in time, less lethality was observed than in patients of the 2nd group (p <0.001; p <0.026, respectively).Conclusion: sonographic signs during the initial examination of a newborn with symptoms of acute diseases or congenital defects of GIT contribute to the timely diagnosis and allow to determine further tactics of investigation and treatment.