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Salman R, Mertiri L, Seghers VJ, Schiess DM, Nguyen HN, Sher AC, Sammer MBK. Ultrasound imaging of bowel obstruction in neonates. J Ultrasound 2024; 27:407-417. [PMID: 38402484 PMCID: PMC11178722 DOI: 10.1007/s40477-023-00858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/09/2023] [Indexed: 02/26/2024] Open
Abstract
Bowel obstruction (BO) in children has a wide differential diagnosis, ranging from non-urgent conditions to surgical emergencies. Abdominal radiographs are most often used as the first imaging modality for the evaluation of obstruction. However, for some indications, ultrasound can be the primary imaging modality. Therefore, it is incumbent on radiologists to recognize the types of bowel obstruction that can be recognized with US. Key sonographic features of BO include differential dilation of bowel loops, bowel wall thickening, and free fluid. "Do Not Miss" findings that indicate need for emergent treatment include volvulus, pneumoperitoneum, and/or signs of ischemia (bowel wall thinning and/or absent perfusion). The aim of this pictorial essay is to provide guidance on the sonographic technique and findings that enable identification of BO on US. Examples of neonatal BO on US, including common and less frequently encountered etiologies, are illustrated in this pictorial essay.
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Affiliation(s)
- Rida Salman
- Division of Body Imaging, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Livja Mertiri
- Division of Body Imaging, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Victor J Seghers
- Division of Body Imaging, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Desi M Schiess
- Pediatric Section, Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - HaiThuy N Nguyen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew C Sher
- Division of Body Imaging, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Marla B K Sammer
- Division of Body Imaging, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
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Nicolescu CR, Cremillieux C, Stephan JL. Duodenogastric Intussusception in a 14-Week-Old Infant with Donohue Syndrome: Case Study. Case Rep Pediatr 2023; 2023:7799234. [PMID: 37885901 PMCID: PMC10599843 DOI: 10.1155/2023/7799234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/24/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
Donohue syndrome (DS) is a rare recessively inherited disorder characterized by severe insulin resistance caused by genetic defects affecting the insulin receptor. The classical clinical characteristics include severe intrauterine growth restriction, craniofacial dysmorphic features, body and skin features, and soft tissue overgrowth. Postnatal growth retardation, cardiac, gastrointestinal, and renal complications, and infection susceptibility develop within the first few months of life, leading to a short life expectancy (<2 years). The classical metabolic abnormalities vary from fasting hypoglycemia to postprandial hyperglycemia with severe hyperinsulinemia. We present the case of a 14-week-old infant with DS who developed cardiac, renal, hepatic, pancreatic, and gastrointestinal features, all of them previously reported in infants with DS. The gastrointestinal features started during the first week of life and included abdominal distension, feeding difficulties, intermittent vomiting, and two episodes of intestinal obstruction. The diagnosis of duodenogastric intussusception was made, and this previously unreported complication tragically resulted in mortality. We discuss how basic mechanisms of cross-talk between insulin and insulin-growth factor 1 receptors could be linked to hyperinsulinemia and its associated comorbidities.
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Affiliation(s)
| | - Clara Cremillieux
- Department of Pediatrics, Centre Hospitalier Universitaire, Saint-Etienne, France
| | - Jean-Louis Stephan
- Department of Pediatrics, Centre Hospitalier Universitaire, Saint-Etienne, France
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Eshel Fuhrer A, Doyev R, Koppelmann T, Shiran SI, Herzlich J, Mandel D, Sukhotnik I, Marom R. Upper gastrointestinal series in healthy neonates with bilious vomiting-is it still obvious? A retrospective observational study. Acta Paediatr 2023; 112:1870-1876. [PMID: 37266967 DOI: 10.1111/apa.16861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/03/2023]
Abstract
AIM Demand for upper gastrointestinal contrast series (UGI) to investigate bilious vomiting (BV) has increased in recent years, mostly due to greater awareness of the need to rule out malrotation and midgut volvulus (MGV). We aimed to examine predictive value of clinical parameters in the management of healthy neonates presenting with BV and re-assess the role of UGI in their management. METHODS A retrospective cohort study including medical, imaging and surgical data of neonates who underwent UGI due to BV. RESULTS A total of 157 term neonates, eight neonates (5.1%) had confirmed surgical diagnosis of malrotation, five of them had malrotation with MGV, including two neonates who underwent extensive intestinal resection due to necrosis. Neonates with a combination of abnormal plain radiograph and abdominal distention had 10 times higher odds of malrotation diagnosis, adjusting for age at first BV (p = 0.017). Neonates with a combination of abnormal plain radiograph, abdominal distention and abdominal tenderness had 25 times higher odds of MGV (p = 0.002). CONCLUSION This study reaffirms the role of UGI as the current main diagnostic tool for malrotation and MGV. Physical examination and plain radiograph findings can help but cannot substitute UGI study.
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Affiliation(s)
- Audelia Eshel Fuhrer
- Department of Pediatric Surgery, Dana-Dwek Children's hospital, Tel Aviv Sourasky medical center, Tel Aviv, Israel
| | - Reut Doyev
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tal Koppelmann
- Department of Pediatric Surgery, Dana-Dwek Children's hospital, Tel Aviv Sourasky medical center, Tel Aviv, Israel
| | - Shelly I Shiran
- Division of Pediatric Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacky Herzlich
- Department of Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mandel
- Department of Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Sukhotnik
- Department of Pediatric Surgery, Dana-Dwek Children's hospital, Tel Aviv Sourasky medical center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronella Marom
- Department of Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sirichamratsakul K, Laochareonsuk W, Surachat K, Sangkhathat S. Population-based prevalence study of common congenital malformations of the alimentary tract and abdominal wall in Thailand: a study using data from the National Health Security Office. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000540. [PMID: 37303481 PMCID: PMC10254801 DOI: 10.1136/wjps-2022-000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background The study aimed to estimate the prevalence of major congenital anomalies of the alimentary system and the abdominal wall in Thailand using a nationwide hospital discharge database from the National Health Security Office (2017-2020). Methods The study extracted data from records with International Classification of Diseases-10 (ICD-10) codes related to esophageal malformation (ESO), congenital duodenal obstruction (CDO), jejunoileal atresia (INTES), Hirschsprung's disease (HSCR), anorectal malformation (ARM), abdominal wall defects (omphalocele (OMP) and gastroschisis (GAS)), and diaphragmatic hernia from the database with patient age selection set to less than 1 year. Results A total of 2539 matched ICD-10 records were found in 2376 individuals over the 4-year study period. Concerning foregut anomalies, the prevalence of ESO was 0.88/10 000 births, while that of CDO was 0.54/10 000 births. The prevalence figures of INTES, HSCR, and ARM were 0.44, 4.69, and 2.57 cases per 10 000 births, respectively. For abdominal wall defects, the prevalences of OMP and GAS were 0.25 and 0.61 cases/10 000 births, respectively. The mortality in our cases was 7.1%, and survival analysis found that associated cardiac defects had a statistically significant influence on survival in most anomalies studied. In HSCR, both Down syndrome (DS) (hazard ratio (HR)=7.57, 95% confidence interval (CI)=4.12 to 13.91, p<0.001) and cardiac defects (HR=5.82, 95% CI=2.85 to 11.92, p<0.001) were significantly associated with poorer survival outcomes. However, only DS (adjusted HR=5.55, 95% CI=2.63 to 11.75, p<0.001) independently predicted worse outcomes by multivariable analysis. Conclusions Our analysis of the hospital discharge database found that the prevalence of gastrointestinal anomalies in Thailand was lower than that reported in other countries, except for HSCR and anorectal malformations. Associated Down syndrome and cardiac defects influence the survival outcomes of these anomalies.
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Affiliation(s)
| | - Wison Laochareonsuk
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Komwit Surachat
- Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- Department of Biomedical Sciences and Biomedical Engineering, Prince of Songkla University, Hat Yai, Thailand
| | - Surasak Sangkhathat
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Chen X, You G, Chen Q, Zhang X, Wang N, He X, Zhu L, Li Z, Liu C, Yao S, Ge J, Gao W, Yu H. Development and evaluation of an artificial intelligence system for children intussusception diagnosis using ultrasound images. iScience 2023; 26:106456. [PMID: 37063466 PMCID: PMC10090215 DOI: 10.1016/j.isci.2023.106456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Accurate identification of intussusception in children is critical for timely non-surgical management. We propose an end-to-end artificial intelligence algorithm, the Children Intussusception Diagnosis Network (CIDNet) system, that utilizes ultrasound images to rapidly diagnose intussusception. 9999 ultrasound images of 4154 pediatric patients were divided into training, validation, test, and independent reader study datasets. The independent reader study cohort was used to compare the diagnostic performance of the CIDNet system to six radiologists. Performance was evaluated using, among others, balance accuracy (BACC) and area under the receiver operating characteristic curve (AUC). The CIDNet system performed the best in diagnosing intussusception with a BACC of 0.8464 and AUC of 0.9716 in the test dataset compared to other deep learning algorithms. The CIDNet system compared favorably with expert radiologists by outstanding identification performance and robustness (BACC:0.9297; AUC:0.9769). CIDNet is a stable and precise technological tool for identifying intussusception in ultrasound scans of children.
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Affiliation(s)
- Xiong Chen
- Department of Paediatric Urology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
- Department of Paediatric Surgery, Guangzhou Institute of Paediatrics, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Guochang You
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, P. R. China
| | - Qinchang Chen
- Department of Pediatric Cardiology, Guangdong Provincial Key Laboratory of Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou 510080, P. R. China
| | - Xiangxiang Zhang
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Na Wang
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Xuehua He
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Liling Zhu
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Zhouzhou Li
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Chen Liu
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Shixiang Yao
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Junshuang Ge
- Clinical Data Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
| | - Wenjing Gao
- Clinical Data Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
- Corresponding author
| | - Hongkui Yu
- Department of Ultrasound, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, P. R. China
- Corresponding author
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Priyadarshi A, Rogerson S, Cruzado R, Crow A, Hinder M, Popat H, Soundappan SSV, Badawi N, Tracy M. Neonatologist-performed point-of-care abdominal ultrasound: What have we learned so far? Front Pediatr 2023; 11:1173311. [PMID: 37187587 PMCID: PMC10175674 DOI: 10.3389/fped.2023.1173311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
This review describes the sonographic appearances of the neonatal bowel in Necrotising enterocolitis. It compares these findings to those seen in midgut-Volvulus, obstructive intestinal conditions such as milk-curd obstruction, and slow gut motility in preterm infants on continuous positive airway pressure (CPAP)-CPAP belly syndrome. Point-of-care bowel ultrasound is also helpful in ruling out severe and active intestinal conditions, reassuring clinicians when the diagnosis is unclear in a non-specific clinical presentation where NEC cannot be excluded. As NEC is a severe disease, it is often over-diagnosed, mainly due to a lack of reliable biomarkers and clinical presentation similar to sepsis in neonates. Thus, the assessment of the bowel in real-time would allow clinicians to determine the timing of re-initiation of feeds and would also be reassuring based on specific typical bowel characteristics visualised on the ultrasound.
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Affiliation(s)
- Archana Priyadarshi
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- Correspondence: Archana Priyadarshi
| | - Sheryl Rogerson
- The Royal Women's Hospital Neonatal Intensive Care Unit, Melbourne, VIC, Australia
| | - Rommel Cruzado
- Department of Radiology, The Children's Hospital Westmead, NSW, Australia
| | - Amanda Crow
- Department of Radiology, The Children's Hospital Westmead, NSW, Australia
| | - Murray Hinder
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Himanshu Popat
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Soundappan S. V. Soundappan
- The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, The Children's Hospital Westmead, NSW, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care at The Children`s Hospital Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Mark Tracy
- Westmead Hospital Neonatal Intensive Care Unit, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
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Chen Y, Zhu LD, Zhou L, Guan AH, Wang ZY, Xiao D, Ma XP, Ren F. The multivariate cox regression model for complete enteral nutrition after primary anastomosis in neonates with intestinal atresia. Front Pediatr 2022; 10:1071056. [PMID: 36578664 PMCID: PMC9791088 DOI: 10.3389/fped.2022.1071056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Enteral feeding after intestinal atresia has always been a concern for clinicians. But the present studies mainly focused on single factors. This research aimed to comprehensively analyze the multiple factors on complete enteral nutrition after primary anastomosis, and establish the convenient prediction model. METHODS We retrospectively collected reliable information in neonates with intestinal atresia form January 2010 to June 2022. The cox regression analysis was performed to select independent risk factors and develop nomogram. Subsequently, ROC curve, calibration curve and decision curve were drawn to thoroughly evaluate the accuracy and applicability of the model. RESULTS The predictors finally included in the model were gestational age, meconium peritonitis, distance from the anastomosis to the ileocecal region, diameter ratio of proximal to distal bowels, and time of initial feeding. The nomogram of predicting the probability of week 2, week 3 and week 4 was drawn and their area under the curve were 0.765, 0.785 and 0.747, respectively. Similarly, calibration and decision curve indicated that the prediction model had a great prediction performance. CONCLUSION The clinical value of predictive models can be recognized. The hope is that the predictive model can help pediatricians reduce hospital costs and parental anxiety.
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Affiliation(s)
- Yang Chen
- Shenzhen Children's Hospital, Shenzhen, China.,College of Medicine, Shantou University, Shantou, China
| | - Le-Dao Zhu
- Shenzhen Children's Hospital, Shenzhen, China
| | - Ling Zhou
- Shenzhen Children's Hospital, Shenzhen, China
| | - Ai-Hui Guan
- Shenzhen Children's Hospital, Shenzhen, China.,College of Medicine, Shantou University, Shantou, China
| | | | - Dong Xiao
- Shenzhen Children's Hospital, Shenzhen, China
| | | | - Feng Ren
- Shenzhen Children's Hospital, Shenzhen, China
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Han Y, Hu S, Chen B, Huang S, Qin Q, Tou J. Meconium Peritonitis, Intestinal Atresia Combined With Biliary Atresia: A Case Report. Front Pediatr 2022; 10:917116. [PMID: 35722473 PMCID: PMC9201381 DOI: 10.3389/fped.2022.917116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Meconium peritonitis (MP) combined with intestinal atresia (IA) is a rare neonatal condition, and it is even rarer in combination with biliary atresia (BA). We describe a case of an infant who developed short bowel syndrome after partial intestinal resection due to MP and IA, along with a Santullienterostomy. During continuous enteral and parenteral nutrition, the stool color became paler. BA was identified by elevated direct bilirubin (DBIL), gamma-glutamyltransferase (GGT), serum matrix metalloproteinase-7 (MMP-7), and hepatobiliary ultrasound; then, Kasai portoenterostomy (KPE) was performed promptly. The Roux-en-Y limb was adjusted intraoperatively to preserve the maximum length of the small intestine while closing the enterostomy. After the operation, the infant gradually adapted to enteral nutrition, his bilirubin level returned to normal, and his weight gradually caught up to the normal range. Although rare, BA should be suspected when MP is combined with IA and when the stool becomes paler in color in the enterostomy state.
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Affiliation(s)
- Yijiang Han
- Department of Neonatal Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuqi Hu
- Department of Neonatal Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Baohai Chen
- Department of Information Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shoujiang Huang
- Department of Neonatal Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qi Qin
- Department of Neonatal Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jinfa Tou
- Department of Neonatal Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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