Prenatal Sonographic Diagnosis and Clinical Management of Fetal Small Bowel Volvulus

Background The purpose of this research is to explore prenatal ultrasound features and clinical managements of fetal small bowel volvulus. At present, researchers mainly focus on the prenatal ultrasound features of fetal small bowel volvulus, and rarely summarize them in combination with the principles of clinical treatment. Methods 11 cases of fetal small bowel volvulus identified by prenatal ultrasound or neonatal surgery in our institution between January 2019 and January 2021 were included. General characteristics of pregnant women, features of prenatal ultrasound, clinical managements and prognosis of neonates were collected. Finally, prenatal ultrasound features and obstetric managements of fetal volvulus was summarized. Results At the first diagnosis, the whirlpool sign and intestinal dilatation were visualized in 11 cases. 3 cases underwent emergency caesarean because of the disappearance of dilated bowel peristalsis, massive ascites and fetal intrauterine hypoxia. The rest 8 cases were followed up by ultrasound, pregnancy outcomes were four regressed intrauterine spontaneously and delivered at term, two underwent emergency caesarean, one premature and one induced labor. 6 cases underwent neonatal surgery immediately after birth and received favorable outcomes.Conclusions Intestinal distention and the whirlpool sign are important ultrasonic features in the diagnosis of fetal small bowel volvulus. The disappearance of intestinal peristalsis of the volvulus segment, massive ascites and intrauterine hypoxia are the main basis for emergency prenatal clinical intervention.

Ethico-legal issues by medical specialism N–V

This chapter covers Ethico-legal issues by medical specialism and includes topics on the following subjects (N-V): Neurology: The clash of rights between a child and parents, Neonatal Surgery: Jehovah’s Witnesses, Neonatology: Consent, Neurosurgery: Information Governance, Neurosurgery: Innovation, Neurosurgery: Preservation of Evidence, Obstetrics: Needle Phobia, Ophthalmology: Statutory Disclosures, Paediatric Cardiology: Unlicensed Equipment, Plastics; Disclosure, Renal: Capacitous adult refusing treatment, Respiratory: Unwise Decisions, Speech: Capacity, Rheumatology: Doctrine of Double Effect, Trauma & Orthopaedics: Necessity, Urology: DOLS, Vascular Surgery: Disclosure

Feasibility of Doppler Ultrasound for Cortical Cerebral Blood Flow Velocity Monitoring During Major Non-cardiac Surgery of Newborns

Background and Aim: Newborns needing major surgical intervention are at risk of brain injury and impaired neurodevelopment later in life. Disturbance of cerebral perfusion might be an underlying factor. This study investigates the feasibility of serial transfontanellar ultrasound measurements of the pial arteries during neonatal surgery, and whether perioperative changes in cerebral perfusion can be observed and related to changes in the perioperative management.Methods: In this prospective, observational feasibility study, neonates with congenital diaphragmatic hernia and esophageal atresia scheduled for surgical treatment within the first 28 days of life were eligible for inclusion. We performed transfontanellar directional power Doppler and pulsed wave Doppler ultrasound during major high-risk non-cardiac neonatal surgery. Pial arteries were of interest for the measurements. Extracted Doppler ultrasound parameters were: peak systolic velocity, end diastolic velocity, the resistivity index and pulsatility index.Results: In 10 out of 14 patients it was possible to perform perioperative measurements; the others failed for logistic and technical reasons. In 6 out of 10 patients, it was feasible to perform serial intraoperative transfontanellar ultrasound measurements with directional power Doppler and pulsed wave Doppler of the same pial artery during neonatal surgery. Median peak systolic velocity was ranging between 5.7 and 7.0 cm s−1 and end diastolic velocity between 1.9 and 3.2 cm s−1. In patients with a vasoactive-inotropic score below 12 the trend of peak systolic velocity and end diastolic velocity corresponded with the mean arterial blood pressure trend.Conclusion: Perioperative transfontanellar ultrasound Doppler measurements of the pial arteries are feasible and provide new longitudinal data about perioperative cortical cerebral blood flow velocity.Trial Registration:https://www.trialregister.nl/trial/6972, identifier: NL6972.