Correlation of placental pathology with the postoperative outcomes and white matter injury in preterm infants following necrotizing enterocolitis

BACKGROUND

To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC.

METHODS

A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions.

RESULTS

In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05-7.54; p = 0.039).

CONCLUSION

Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.

Ontogeny and development of the gastrointestinal system in Indian walking catfish (Clarias magur) during its early development

Ontogeny of the digestive tract and its accessory organs and their further development in the Indian walking catfish (Clarias magur) were examined in larvae, starting from the day of hatching until 35 days post-hatching (dph) reared at 28-29 °C. Many organs at their primordial stage were seen on the day of hatching. These include opened oral cavity with monolayered epithelial lining and very few newly emerging taste buds and goblet cells, primordial pharyngeal teeth on slightly stratified epithelia of the pharyngeal plate, stomach anlage with some degree of the mucosal fold, and a few newly forming gastric glands embedded under its mucosa, primordial anterior and posterior intestine with the smooth mucosal surface, anal opening, and primordial liver and pancreas. At 1 dph, the stomach appeared to be bilobed with the first evidence of food particle in it, and the intestine had some initial folding. On the day of hatching, goblet cells appeared in all lengths of the gut, but not densely, except in the stomach; on it, they appeared at 2 dph. Pancreatic zymogen granules also appeared on this day. Supranuclear vesicles first appeared on 4-5 dph (7.9 ± 0.5-8.6 ± 0.8 mm TL), and they continue to exist until 35 dph. The developmental sequence in this fish confirmed it as an altricial species with some major histomorphological events after the onset of feeding; these include-the appearance of fully developed-pharyngeal teeth at 4 dph and onwards, pyloric sphincter, anterior to posterior intestinal sphincter at 6 dph, and the continuous development of buccopharyngeal cavity and stomach in their shape, size, and functionality until the completion of metamorphosis. Overall, the information on gastrointestinal development in the early life stage of C. magur will be useful for understanding its larval digestive physiology, and this, in turn, will help in designing effective larval feed for growth and survival.

An experience of ultrasound-guided hydrostatic reduction of intrussusception at a tertiary care centre

BACKGROUND

Intussusception is an important and one of the most commonly encountered diagnoses of intestinal obstruction in the paediatric age group. Ultrasound-guided hydrostatic reduction is an effective, nonoperative treatment modality for this condition and is associated with a high success rate. In addition, it is simple and safe as the entire procedure is carried out with real-time ultrasound, without the hazard of radiation. The aim of this study was to evaluate the effi cacy and safety of ultrasound-guided hydrostatic reduction in the management of intussusceptions in the paediatric age group.

METHOD

A case study was carried out on 89 patients diagnosed with intussusception using high-resolution ultrasonography over a period of two years, spanning February 2012 to January 2014. Ultrasound-guided hydrostatic reduction was performed in 78 of these patients, and 11 patients were excluded owing to clinical contraindications. Follow-up ultrasound was performed after 24 hours to rule out recurrence.

RESULTS

The disease was most prevalent in the age group 6-24 months. The ileocolic type was the most common. Mean duration (hours) was 17.02 ± 20.81 for time to presentation. Complete therapeutic reduction was achieved in 70 of the 78 cases, with a success rate of 90%. Two recurrences occurred in the following 24 hours, which were successfully reduced on the second attempt. Complications and mortality did not occur secondary to the procedure.

CONCLUSION

Our study found that ultrasound-guided hydrostatic reduction is a simple, safe and effective nonoperative treatment for intussusceptions in the paediatric age group, and should be the fi rst line of management in appropriate patients.