Intussusception in a preterm newborn

Clinical manifestation and treatment of intussusception in children aged 3 months and under : a single centre analysis of 38 cases

BACKGROUND

Intussusception is the leading cause of acute abdominal conditions in infants, yet it is frequently under-recognised in those younger than 3 months, potentially resulting in serious complications such as bowel necrosis, peritonitis, or even death if not promptly treated. This retrospective study aims to enhance clinicians' understanding of the diagnosis and management of acute intussusception in this age group to prevent poor prognosis.

METHODS

The clinical data of 38 infants aged ≤ 3 months diagnosed with intussusception at Wuhan Children's Hospital between January 2013 and July 2024 were retrospectively analyzed. Patients were categorized into two groups based on the outcome of nonoperative reduction: the successful group and the failed group. The study examined demographic characteristics, clinical presentations, imaging findings, treatment modalities, and outcomes to identify patterns and evaluate the effectiveness of diagnostic and therapeutic approaches.

RESULTS

During the study period, 12,206 children were diagnosed with intussusception, including 38 (0.31%) infants aged 3 months or younger (mean age: 73.6 days; 20 males and 18 females). The most frequently reported symptoms were vomiting (36 cases), bloody stool (27 cases), and intermittent crying (18 cases). Ultrasonography (USG) confirmed the diagnosis in 97.4% of cases. A total of 27 (71.1%) infants treated with enema reduction, with a success rate of 48.1% (13/27). Enema-related perforation occurred in 2 cases (7.4%). An additional 11 cases (28.9%) proceeded directly to laparotomy, with 5 (15.8%) diagnosed as secondary intussusception. Bowel resection was necessary in 6 of the 25 surgical cases due to necrosis. Each infant responded well to treatment and was discharged in stable condition.

CONCLUSIONS

The clinical manifestations of intussusception in infants aged 3 months and below are sometimes atypical. Early USG should be performed to make a clear diagnosis, and the effect of early intervention is satisfactory. In infants with good general condition, enema reduction can be attempted first with appropriate pressure monitoring to avoid bowel perforation.

Intussusception in preterm neonates: A systematic review of a rare condition

Background

While necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admitted to neonatal intensive care unit (NICU), intussusception is exceedingly uncommon and often overlooked. This is due to the fact that they share many clinical characteristics. The initial misdiagnosis of intussusception in preterm neonates (IPN) especially has led to a delay in their management, which increases the risk of developing compromised bowel. Additionally, it is difficult to reach a diagnosis as neonatal intussusception does not have any classical radiological signs even when contrast enema is used. This systematic review is based on the published literature including case reports and case series to review the clinical features of IPN and how to differentiate it from NEC in order to shed the light on this rare disease and how having a high index of suspicion would help practitioners to make an early and accurate diagnosis

Methods

A systematic literature search to report all cases of relevant articles that reported IPN till date. All cases that were born before 37 weeks gestational age, presented within the neonatal period and having well established documentation were included in the study. Any case that did not have these criteria was excluded from our study.

Results

Only 52 cases met these criteria during the period from 1963 till date. An average of 10 days had elapsed before the cases were confirmed to have IPN either clinically or intraoperatively. The most frequent manifestations were abdominal distension and bilious gastric residuals, occurring in 85% and 77% of the cases respectively, followed by bloody stools in 43% of cases. However, this triad was present only in approximately one-third of the cases. Only 13 cases were diagnosed as having intussusception preoperatively. About two thirds of the intussusception were located in the ileum. Pathological lead point was present in 7 cases only; 4 of them were due to Meckel’s diverticulum. Nine cases only out of the 52 cases with IPN died.

Conclusion

It is crucial to detect the clues for diagnosis of intussusception because in contrast to NEC, it is unresponsive to conservative management, affects the viability of the bowel and surgery is essential.

Intussusception in the Neonate: A Case Study

Intussusception is the most common cause of intestinal obstruction in infants and toddlers; however, it is a rare entity in neonates. During intussusception, a proximal portion of the bowel pushes inside the adjacent, distal segment of the bowel in a telescoping fashion leading to obstruction, strangulation of the mesentery, ischemia, and necrosis. The etiology of intussusception is often unknown and there are currently no preventive techniques. Intussusception often mimics other common disease processes affecting neonates; this can result in detrimental delays in diagnosis and treatment. Intussusception is considered a surgical emergency and a delay in treatment results in significant morbidity and mortality. With proper education on this rare complication, neonatal nurses play a vital role in early diagnosis. To improve the care of neonates affected, it is imperative that intussusception remain a differential diagnosis for clinicians.