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Abdelmaksoud S, Kronfli R, Makin E, Davenport M. Antenatally Detected Choledochal Malformation: What Are We Waiting For? J Pediatr Surg 2024:S0022-3468(24)00176-3. [PMID: 38582706 DOI: 10.1016/j.jpedsurg.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION An increasing proportion of congenital choledochal malformation (CCM) are being detected on antenatal ultrasound. However, the actual timing of its surgical correction remains controversial with some series showing an excess of complications the earlier the operation. The aim of this study was to characterize the pathophysiological aspects of this cohort from the perspective of age at surgery in order to inform a more rational basis for clinical decision-making. METHODS We analysed a prospective database of CCM acquired over a 26-year period (Jan. 1997 to Dec. 2022) for patient demography; details of pre- and post-natal imaging; age at surgical intervention; operative complications (Clavien-Dindo classification) and outcome. Data are quoted as median (IQR). All comparisons are non-parametric. A P value of 0.05 was accepted as significant. RESULTS There were 58 (72% female) children with an antenatally-detected CCM from a total of 265 (21.8%) in the series. These were classified as Type 1C (n = 47; 81%), type 4C (n = 3; 5%) and Type 5 (n = 8; 14%). There were no Type 1F lesions in this cohort. Median age at surgery was 113 (IQR 57-198) days. Postnatal cyst (US) size varied from 12 to 130 mm but there was little evidence of a relationship between this and post-natal liver biochemistry (e.g. bilirubin rS = 0.01, P = 0.44; AST rS = 0.14, P = 0.19). Choledochal pressure measurements (n = 46) showed resting pressures of 12 (9-21) mmHg with no significant correlation with age (P = 0.4) or aspartate aminotransferase (P = 0.2) or γ-glutamyl transferase (P = 0.06). The cohort was divided into 2 groups (Early and Late) based on the median age at surgery (all open) (113 days). Biliary obstruction was more common in the Early group (10 vs. 2; P = 0.01). Two perforations occurred, both in the Early group. With a deliberate policy of regular ultrasound-based follow-up we have seen no anastomotic complications (leak, stenosis, persistent intrahepatic biliary dilatation or stones) or post-operative cholangitis in any child [median follow-up 3.42 (1.30-8.05) years]. CONCLUSIONS This is one of the largest series documenting the outcomes of antenatally-detected CCMs, certainly in Europe and North America. Such lesions are invariably cystic in nature, and either Types 1C, 4C or 5. The absence of complications using a policy of early intervention (where possible) in experienced hepatobiliary units was shown. EVIDENCE LEVEL II.
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Affiliation(s)
- Sherif Abdelmaksoud
- Dept. of Paediatric Surgery, Kings College Hospital, London SE5 9RS, United Kingdom
| | - Rania Kronfli
- Dept. of Paediatric Surgery, Kings College Hospital, London SE5 9RS, United Kingdom
| | - Erica Makin
- Dept. of Paediatric Surgery, Kings College Hospital, London SE5 9RS, United Kingdom
| | - Mark Davenport
- Dept. of Paediatric Surgery, Kings College Hospital, London SE5 9RS, United Kingdom.
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Yuan L, Lv B, Wang H, Wang Z, Shang H, Li X, Liang L, Lin X. T2-weighted Imaging Features of the Fetal Thymus in the Middle and Late Pregnancy: A Post-mortem Study based on Magnetic Resonance Imaging. Curr Med Imaging 2024; 20:CMIR-EPUB-139009. [PMID: 38462829 DOI: 10.2174/0115734056282196240105060732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Fat-suppressed (FS) T2-weighed turbo spin-echo (TSE) sequence was used to detect the signal of the thymus and the characteristics of the thymus location, measure the two-dimensional diameter at specific levels, and analyze the association with gestational weeks. METHODS This study involved 51 fetal specimens. Post-mortem MRI scanning was implemented with a 3.0-T MRI system. T2-weighted imaging (T2WI) features of the thymus in fetuses were quantitatively investigated with DICOM images. Statistical analysis was done with the Chi-Square test, oneway ANOVA, and Student's t-test. RESULTS There was heterogeneity in the morphology of the fetal thymus. FS T2-weighted TSE sequence clearly exhibited the microstructure of the fetal thymus. The thymus extensively showed a lobulated appearance. The central signal is much higher than the peripheral signal in each lobule. In addition, FS-T2WI images can clearly show the interlobular septum, which is filled with fluid and presents a linear high signal. The signal intensity of fetal thymus increased with gestational weeks. The diameter measured in a particular plane was highly correlated with gestational week. CONCLUSION FS T2-weighted TSE sequence provides high-resolution images of the fetal thymus. The change in signal intensity, location, and two-dimensional diameter in a specific plane can be used as a research direction for the fetal thymus.
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Affiliation(s)
- Leilei Yuan
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai'an 271099
| | - Baohua Lv
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai'an 271099
| | - Han Wang
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai'an 271099
| | - Zhaohua Wang
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai'an 271099
| | - Hua Shang
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai'an 271099
| | - Xiujuan Li
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai'an 271099
| | - Lisha Liang
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai'an 271099
| | - Xiangtao Lin
- Medical Integration and Practice Center, Shandong University, Jinan 250012, China
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250012, China
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Chertin L, Neeman BB, Jaber J, Verhovsky G, Zisman A, Mamber A, Kafka I, Natsheh AE, Koulikov D, Shenfeld OZ, Chertin B, Koucherov S, Neheman A. Our experience with management of congenital urological pathologies in adulthood: What pediatric urologists should know and adult urologists adopt in pediatric practice experience. Curr Urol 2024; 18:7-11. [PMID: 38505161 PMCID: PMC10946651 DOI: 10.1097/cu9.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/19/2023] [Indexed: 03/21/2024] Open
Abstract
Purpose To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. Materials and methods We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. Results The study included 102 patients with a median age of 25 (interquartile range, 23-36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12-54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1-2). Conclusions Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.
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Affiliation(s)
- Leon Chertin
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Binyamin B. Neeman
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Jawdat Jaber
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Guy Verhovsky
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Ariel Mamber
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ilan Kafka
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ala Eddin Natsheh
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Dmitry Koulikov
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ofer Z. Shenfeld
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Boris Chertin
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Stanislav Koucherov
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Amos Neheman
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
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Amghar A, El Abbassi I, Mohammed J, Asmaa A, Amine L, Bouhya S. Radiological characteristics of the posterior fossa of the fetal skull and presentation of a rare case of antenatal screening for Dandy-Walker malformation using antenatal fetal ultrasound and MRI. Int J Surg Case Rep 2024; 115:109037. [PMID: 38184950 PMCID: PMC10808924 DOI: 10.1016/j.ijscr.2023.109037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Dandy-Walker malformation is a rare congenital anomaly of the brain that mainly affects the cerebellum region. It is characterised by abnormal dilatation of the fourth ventricle of the brain and partial or total absence of the cerebellar vermis. This malformation may also be accompanied by other anomalies of the brain. Ante-natal diagnosis is becoming increasingly frequent given the performance of medical imaging, in particular ante-natal ultrasound and MRI. The object of this article is to clarify the possible causes of rare cystic malformations of the posterior cerebral fossa, which are very rare congenital malformations. CASE PRESENTATION a 30 year old patient, second gesture, mother of a live child by caesarean section, referred to us at 32 weeks of amenorrhoea at the university hospital centre for management of a cystic malformation of the posterior cerebral malformation detected on 2nd trimester ultrasound and confirmed as a Dandy Walker malformation on 3rd trimester fetal MRI. CLINICAL DISCUSSION The Dandy-Walker malformation can be described on prenatal MRI as vermian hypoplasia and can be detected as early as the 1st trimester of pregnancy using ultrasound, This cystic malformation poses a problem of differential diagnosis with other pathologies which also result in a cystic image of the posterior cerebral fossa, in particular Black's pouch cyst, arachnoid cyst and mega magna cistern, which requires careful interpretation of cerebral MRI of the foetus. CONCLUSION Imaging techniques play a fundamental role in diagnosis. Prenatal ultrasound and MRI can reveal a Dandy-Walker malformation as early as the 2nd month of pregnancy. MRI is ideal for differentiating differential diagnoses.
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Affiliation(s)
- Ayoub Amghar
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Imane El Abbassi
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Jalal Mohammed
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Assal Asmaa
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
| | - Lamrissi Amine
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Said Bouhya
- Obstetrics and Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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Konar L, Konar C, Kumar V. Amniotic Band Syndrome: A Rare Obstetric Complication. J Obstet Gynaecol India 2023; 73:284-286. [PMID: 38143985 PMCID: PMC10746659 DOI: 10.1007/s13224-023-01849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/30/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Lisley Konar
- Third Year Junior Resident, Sri Devraj Urs Medical College, Kolar, Karnataka India
| | - Chandrachur Konar
- Assistant Professor, Department OB-GYN, Sri Devraj Urs Medical College, Kolar, Karnataka India
| | - Vasanth Kumar
- Professor, Department OB-GYN, Sri Devraj Urs Medical College, Kolar, Karnataka India
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Tosto V, Herrero B, Illescas T, De la Calle Fernandez-Miranda M, Moreno-Sanz B, de Lucas R, Bartha JL, Antolin E. (New) antenatal ultrasound signs of fetal junctional epidermolysis bullosa: A case report and systematic review of literature. Eur J Obstet Gynecol Reprod Biol 2023; 290:43-50. [PMID: 37717401 DOI: 10.1016/j.ejogrb.2023.08.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023]
Abstract
Epidermolysis bullosa is a rare hereditary autosomal disease that is included in the heterogeneous group of genodermatosis. It is characterized by skin and mucous membranes fragility and denudation, and it can be associated with pyloric atresia. Prognosis is often poor, and death can occur in neonatal period due to severe sepsis. We present a case of fetal junctional epidermolysis bullosa in a consanguineous couple, highly suggested by previous obstetric history and several antenatal ultrasound signs, such as polyhydramnios, gastric enlargment, the "snowflake sign", abnormal external ears, signs of skin desquamation, lower limbs anomalies and chorioamniotic membrane separation. We describe a marked perioral hipoecogenicity as a novel sign of skin-mucous denudation, which could be helpful for future diagnosis. A review of literature, focused specifically on the antenatal sonography role, is also reported. Prenatal ultrasound-based diagnosis of epidermolysis bullosa is difficult, especially in apparently low risk contexts, but may be possible.
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Affiliation(s)
- Valentina Tosto
- Giannina Gaslini Children's Hospital, Department of Obstetrics and Gynecology, Genova, Italy; La Paz University Hospital Gynaecology and Obstetrics Service, Fetal Medicine Unit. Institute for Health Research-IdiPAZ, Madrid, Comunidad de Madrid, ES, Spain
| | - Beatriz Herrero
- La Paz University Hospital Gynaecology and Obstetrics Service, Fetal Medicine Unit. Institute for Health Research-IdiPAZ, Madrid, Comunidad de Madrid, ES, Spain
| | - Tamara Illescas
- La Paz University Hospital Gynaecology and Obstetrics Service, Fetal Medicine Unit. Institute for Health Research-IdiPAZ, Madrid, Comunidad de Madrid, ES, Spain
| | - Maria De la Calle Fernandez-Miranda
- La Paz University Hospital Gynaecology and Obstetrics Service, Fetal Medicine Unit. Institute for Health Research-IdiPAZ, Madrid, Comunidad de Madrid, ES, Spain
| | - Barbara Moreno-Sanz
- La Paz University Hospital, Department of Neonatology Madrid, Madrid, ES, Spain
| | - Raul de Lucas
- La Paz University Hospital, Pediatric Dermatology Section. Madrid, Madrid, ES, Spain
| | - Josè Luis Bartha
- La Paz University Hospital Gynaecology and Obstetrics Service, Fetal Medicine Unit. Institute for Health Research-IdiPAZ, Madrid, Comunidad de Madrid, ES, Spain; Autonomous University of Madrid, Universidad Autonoma de Madrid (UAM), Madrid, ES, Spain
| | - Eugenia Antolin
- La Paz University Hospital Gynaecology and Obstetrics Service, Fetal Medicine Unit. Institute for Health Research-IdiPAZ, Madrid, Comunidad de Madrid, ES, Spain; Autonomous University of Madrid, Universidad Autonoma de Madrid (UAM), Madrid, ES, Spain.
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Singal K, Adamczyk K, Hurt L, Woolner A, Paranjothy S. Isolated choroid plexus cysts and health and developmental outcomes in childhood and adolescence - A systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 290:115-122. [PMID: 37778251 DOI: 10.1016/j.ejogrb.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES Choroid plexus cysts (CPCs) are incidental findings on ultrasound examination of the fetal brain. It is not known if isolated CPCs are associated with any adverse health or neurodevelopmental outcomes during the life course. This systematic review aimed to collate and synthesize the evidence on whether or not isolated choroid plexus cysts are associated with an increased risk of adverse health or developmental outcomes during childhood and adolescence. METHODS A search strategy was developed specifically for this study and applied to four electronic databases Medline (Ovid), Embase (Ovid), Web of Science, and Google Scholar. Studies were assessed and selected for inclusion if there was a measurement of CPC (including single or multiple; unilateral or bilateral; isolated or presenting alongside other markers) during the antenatal or early neonatal period (<7 days) with follow-up of children and adolescents for health and developmental outcomes measured at any time from age 1 month onwards. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Due to heterogeneity in the types of outcome measures included and the timing of measurement of outcomes across the studies, it was not possible to pool data across studies and a narrative description of findings was presented. RESULTS Eight studies (three cohorts and five case series) met the inclusion criteria. Different methods were used for outcome assessment, such as in-person assessment, parent questionnaires, medical records, and telephone interviews with parents. Six studies measured outcomes only once during the specified duration of follow-up; two studies carried out paediatric reviews of the children several times during follow-up. There were no differences in developmental outcomes or physical health between babies with CPCs reported in the three cohort studies, and no abnormalities were detected in the children that were followed up in four of the five case series studies. Most of the included studies were graded as low quality due to the small sample size, high risk of selection bias, unclear definitions of CPC or lack of a comparison group. CONCLUSIONS The studies conducted to date do not provide evidence of adverse physical health outcomes or neurodevelopmental delays in babies with CPCs. However, most of these studies were small and included a narrow range of outcomes. Further research is needed to explore the relative incidence of outcomes such as ASD, ADHD, epilepsy and educational attainment in children with CPCs.
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Affiliation(s)
- Kusum Singal
- Aberdeen Center for Health Data Sciences, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom.
| | - Krzysztof Adamczyk
- Aberdeen Center for Health Data Sciences, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom.
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Andrea Woolner
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom.
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Tatterton MJ, Fisher MJ. 'You have a little human being kicking inside you and an unbearable pain of knowing there will be a void at the end': A meta-ethnography exploring the experience of parents whose baby is diagnosed antenatally with a life limiting or life-threatening condition. Palliat Med 2023; 37:1289-1302. [PMID: 37129319 PMCID: PMC10548777 DOI: 10.1177/02692163231172244] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Parents of babies diagnosed with life limiting conditions in the perinatal period face numerous challenges. Considerations include the remainder of the pregnancy, delivery of the baby and decisions around care in the neonatal period. AIM To increase understanding of how parents experience the diagnosis of a life-limiting or life-threatening condition, during pregnancy and following the birth of their baby, by answering the question: 'what is known about the perinatal experiences of parents of babies with a life-limiting or life-threatening diagnosis?' DESIGN A meta-ethnography was conducted to synthesise findings from existing qualitative evidence. DATA SOURCES British Nursing Database, CINAHL, Medline, PsycINFO and Embase databases were searched in January 2023. FINDINGS Relationships between parents and their families and friends, and with professionals influence the needs and experiences of parents, which oscillate between positive and negative experiences, throughout parents' perinatal palliative care journey. Parents highlighted the need for control and a sense of normality relating to their parenting experience. Validation was central to the experience of parents at all stages of parenthood. Relationships between the parent and the baby were unwavering, underpinned with unconditional love. CONCLUSION Professionals, family members and friendship groups influence the experience, validating parents and their baby's identity and supporting parents in having a sense of control and normality by demonstrating empathy, and providing time and clear communication.
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Affiliation(s)
- Michael J Tatterton
- School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
- Bluebell Wood Children’s Hospice, North Anston, Sheffield, UK
- International Children’s Palliative Care Network, c/o Together for Short Lives, Bristol, UK
| | - Megan J Fisher
- School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
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Singh N, Mandelia A, Nigam N, Yadav S, Pradhan M. Fetal Klippel-Trenaunay-Weber Syndrome: Antenatal Diagnosis and Postnatal Management. J Indian Assoc Pediatr Surg 2023; 28:387-391. [PMID: 37842217 PMCID: PMC10569273 DOI: 10.4103/jiaps.jiaps_170_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/01/2023] [Accepted: 03/21/2023] [Indexed: 10/17/2023] Open
Abstract
Context Klippel-Trenaunay-Weber syndrome (KTWS) is a rare disease characterized by a triad of venous malformations, vascular skin nevus and asymmetric hypertrophy of bone and soft tissue. The spectrum of disease in utero varies from asymptomatic nevus flammeus to life threatening complications like Kasabach-Merritt phenomena. Aim The aim of this study was to review our experience of antenatal diagnosis of KTWS and it's postnatal management. Settings and Design This was a retrospective observational study of all pregnant women who were antenatally diagnosed with KTWS and postnatally confirmed at a tertiary care center in north India between 2012 and 2021. Subjects and Methods The electronic medical records were reviewed and data were collected regarding demographic information, obstetric history, clinical presentation, sonographic findings, mode of delivery, fetal outcome, and follow-up. Results During the study period, four fetuses were diagnosed with KTWS on sonography. Three women were multigravida whereas one was a primigravida. Two women opted for medical termination of pregnancy and one each had liveborn child and an intra-uterine fetal death. KTWS was confirmed in all cases. The liveborn child underwent treatment for the vascular malformation and is alive at 4 years of age. Conclusions This study attempts to add onto the available literature regarding the spectrum of prenatal presentations of KTWS. It emphasizes the importance of prenatal diagnosis and follow-up of the fetus/neonate.
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Affiliation(s)
- Neeta Singh
- Department of Maternal and Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Mandelia
- Department of Pediatric Surgical Superspecialities, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Nigam
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sangeeta Yadav
- Department of Maternal and Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mandakini Pradhan
- Department of Maternal and Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Peacock G, Kothari D, D'Orsogna L, Dickinson JE, Andrews D, Yim D. The Impact of Prenatal Diagnosis on Clinical Outcomes of Isolated Vascular Rings From a Statewide Paediatric Cardiology Tertiary Service. Heart Lung Circ 2023; 32:735-744. [PMID: 37061362 DOI: 10.1016/j.hlc.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/07/2023] [Accepted: 03/14/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Vascular rings, including right aortic arch with aberrant left subclavian artery (RAA-ALSCA), double aortic arch (DAA) and pulmonary artery sling (PAS), are congenital anomalies that may cause airway and oesophageal compression. As prenatal detection has improved, literature comparing clinical outcomes of antenatally versus postnatally diagnosed cases continues to emerge. The aim is to define a statewide tertiary paediatric institution's clinical profile and outcomes of prenatal versus postnatally diagnosed isolated vascular rings. METHOD A retrospective single-centre review of isolated RAA-ALSCA, DAA and PAS between 1 January 1999 and 31 December 2020 was conducted. Clinical characteristics, surgical and follow-up information were collected. Antenatal and postnatally diagnosed groups were compared. RESULTS Out of 123 cases diagnosed with isolated vascular rings, 98 (79.7%) cases had RAA-ALSCA, 21 (17.1%) with DAA, 4 (3.3%) with PAS. The antenatal detection rate was 73.6% in the past decade; 20.3% had a genetic disorder, of which 48% had 22q11.21 microdeletion. Of prenatally diagnosed cases, 31.3% developed symptoms, commonly stridor and dysphagia, at a median age of 2.0 months (IQR 0.0-3.0), compared to a median age of diagnosis for the postnatal cohort of 9 months (IQR 1.0-40.7). Postnatally diagnosed cases were more likely to present with symptoms, primarily respiratory distress, than prenatally diagnosed cases (p=0.006). Fifty-nine (59) cases (50% antenatally diagnosed) required vascular ring division; 6.8% had residual symptoms following surgery. DISCUSSION Antenatal diagnosis has improved and leads to better parental awareness and more timely, appropriate intervention. Postnatally diagnosed patients were older, more likely to be symptomatic, underwent more investigations and were commenced on more medications for symptom management prior to diagnosis. One in five cases of isolated vascular ring anomalies carried a genetic diagnosis, which has important implications on prenatal counselling and genetic testing.
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Affiliation(s)
- Giulia Peacock
- Department of Paediatric Cardiology, Perth Children's Hospital, Perth, WA, Australia
| | - Darshan Kothari
- Department of Paediatric Cardiology, Perth Children's Hospital, Perth, WA, Australia
| | - Luigi D'Orsogna
- Department of Paediatric Cardiology, Perth Children's Hospital, Perth, WA, Australia
| | - Jan E Dickinson
- Department of Maternal Fetal Medicine, King Edward Memorial Hospital, Perth, WA, Australia; Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - David Andrews
- Department of Cardiothoracic Surgery, Perth Children's Hospital, Perth, WA, Australia
| | - Deane Yim
- Department of Paediatric Cardiology, Perth Children's Hospital, Perth, WA, Australia.
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Damiani GR, Arezzo F, Vimercati A, Del Boca G, Biffi A, Gaetani M, Cicinelli E. Thrombosed Arteriovenous Malformation of Umbilical Cord. J Obstet Gynaecol India 2023; 73:287-289. [PMID: 37324371 PMCID: PMC10267090 DOI: 10.1007/s13224-022-01635-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/14/2022] [Indexed: 10/18/2022] Open
Abstract
Background Arteriovenous malformation of umbilical cord is an extremely rare congenital malformation. Causes of this condition are unknown. AVM of umbilical cord can cause significant complications in the developing fetus. Methods We report our management of the case with accurate ultrasound study that could improve and facilitate the approach to this pathology due to the lack of literature and with an overview of the available literature. Results There are only two cases of umbilical AVM diagnosed in the prenatal period with associated pathology. The mainstay of prenatal detection is the accurate study of umbilical cord also even if it is not requested from the actual guide lines in a way to improve the perinatal morbidity and mortality.
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Affiliation(s)
- Gianluca Raffaello Damiani
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Francesca Arezzo
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Antonella Vimercati
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Gregorio Del Boca
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
- ASST-Lecco, Leopoldo Mandic Hospital, Lecco, Italy
| | - Anna Biffi
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
- ASST-Lecco, Leopoldo Mandic Hospital, Lecco, Italy
| | - Maria Gaetani
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
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12
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Lamrissi A, Mourabbih M, Ouajih O, Jalal M, Fichtali K, Bouhya S. Amniotic band syndrome: A case report. Int J Surg Case Rep 2022; 95:107096. [PMID: 35567876 PMCID: PMC9112021 DOI: 10.1016/j.ijscr.2022.107096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022] Open
Abstract
Amniotic band syndrome is a rare disorder, which consists of a combination of malformations in which the main feature is the existence of an amniotic band that can envelop the limbs, the body wall, and/or the viscera. We report a case of an antenatal diagnosis of amniotic band syndrome in a 21-year-old female patient at 20 SA + 1 day, who had a medical abortion.
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Affiliation(s)
- A Lamrissi
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco; Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco; Biology and Health Laboratory (LBS), Hassan 2 University of Casablanca, Morocco.
| | - M Mourabbih
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco; Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - O Ouajih
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco; Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - M Jalal
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco; Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - K Fichtali
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco; Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - S Bouhya
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco; Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco; Biology and Health Laboratory (LBS), Hassan 2 University of Casablanca, Morocco
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13
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Lamrissi A, Madri F, Charkaoui M, Mourabbih M, Jalal M, Bouhya S. Acro-callous syndrome: A case report. Int J Surg Case Rep 2022; 96:107210. [PMID: 35738142 PMCID: PMC9218811 DOI: 10.1016/j.ijscr.2022.107210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 04/30/2022] [Accepted: 05/14/2022] [Indexed: 02/07/2023] Open
Abstract
A malformative syndrome of unknown prevalence, the diagnosis is based on morphological ultrasound and magnetic resonance imaging of the fetus. The transmission is genetic and autosomal recessive. Courtnes has established 4 diagnostic criteria to affirm the acrocal syndrome and to eliminate the amalgam with other polymalformative syndrome.
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Affiliation(s)
- A. Lamrissi
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco,Biology and Health Laboratory (LBS), Hassan 2 University of Casablanca, Morocco,Corresponding author at: Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco.
| | - F.E. Madri
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - M. Charkaoui
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - M. Mourabbih
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - M. Jalal
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - S. Bouhya
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco,Biology and Health Laboratory (LBS), Hassan 2 University of Casablanca, Morocco
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14
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Bhardwaj P, Thattaruparambil VP, Vellaisamy G, Mahadevaiah S, Hegde S. Gastric teratoma presenting as melena in the newborn: A case report. J Neonatal Perinatal Med 2022; 15:667-669. [PMID: 35694937 DOI: 10.3233/npm-210931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Melena is reported in 1 of 350 to 400 new-borns. Significant upper gastrointestinal bleeding in a neonate with an antenatally diagnosed abdominal mass has not been reported before. This case highlights an unusual presentation of a gastric teratoma and proposes a probable embryological explanation for the site of occurrence.
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Affiliation(s)
- P Bhardwaj
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - V P Thattaruparambil
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - G Vellaisamy
- Department of Pathology, St. John's Medical College, Bengaluru, India
| | - S Mahadevaiah
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
| | - S Hegde
- Department of Pediatric Surgery, St. John's Medical College Hospital, Bengaluru, India
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15
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Memon D, Vaidyanathan B. Prenatal diagnosis of obstructed supracardiac total anomalous pulmonary venous connection at 23 weeks with successful immediate postnatal surgical correction. Ann Pediatr Cardiol 2021; 14:432-436. [PMID: 34667423 PMCID: PMC8457286 DOI: 10.4103/apc.apc_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/20/2020] [Accepted: 12/13/2020] [Indexed: 11/08/2022] Open
Abstract
Diagnosis of isolated total anomalous pulmonary venous connections (TAPVCs) is relatively rare in fetal life, especially in early gestation. We report a case of a fetus diagnosed with the supracardiac type of TAPVC at 23 weeks gestation, with evidence of obstruction to connection of the common vertical vein to the superior vena cava. The neonate had a critical presentation at birth and underwent an emergency surgical repair immediately after birth with excellent outcome on short term follow-up with the resolution of pulmonary artery hypertension.
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Affiliation(s)
- Danish Memon
- Department of Paediatric Cardiology, Division of Fetal Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balu Vaidyanathan
- Department of Paediatric Cardiology, Division of Fetal Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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16
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Karavadara D, Davidson JR, Story L, Diab Y, Upadhyaya M. Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre. Pediatr Surg Int 2021; 37:1281-1286. [PMID: 34235545 PMCID: PMC8325645 DOI: 10.1007/s00383-021-04935-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aetiology and management of ovarian pathology in children differs between antenatal and postnatal lesions. However, all lesions may present acutely due to adnexal torsion. In this setting, opportunities to preserve fertility with ovary-sparing surgery (OSS) may be missed. Some studies suggest that pediatric and adolescent gynaecology (PAG) input in care is associated with OSS. METHODS A retrospective cohort study of children undergoing surgery for ovarian pathology at a tertiary pediatric surgery centre over an 8-year period (2011-2018). Patient factors, lesion characteristics and PAG involvement were examined for association with OSS using multivariate logistic regression. RESULTS Thirty-five patients with ovarian pathology managed surgically were included. Ten were infants with lesions detected antenatally; all were managed by pediatric surgeons (PS) alone at median age 2 weeks (1 day-25 weeks). Twenty-five patients presented postnatally at median age 11 (0.75-15) years. In total, there were 16 cases of adnexal torsion, each managed primarily by PS. Twelve underwent oophorectomy and six (50%) of these cases had viable ovarian tissue on histology. Furthermore, two infants with large simple cysts were similarly managed by unnecessary oophorectomy based on histology. Overall rate of OSS was 46% and PAG involvement was the only factor associated with ovarian salvage. CONCLUSION Differences in surgical management between PAGs and PS may be attributable to the different patient populations they serve. We recommend improving the knowledge of PS trainees in OSS approaches for adnexal torsion and large benign lesions.
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Affiliation(s)
- D Karavadara
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK
- King's College London School of Medicine, London, UK
| | - J R Davidson
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
- Stem Cells and Regenerative Medicine, GOS-UCL Institute of Child Health, London, UK.
- Prenatal Cell and Gene Therapy, EGA-UCL Institute for Women's Health, London, UK.
| | - L Story
- King's College London School of Medicine, London, UK
- Department of Obstetrics, Gynaecology and Maternal-Fetal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Y Diab
- Department of Obstetrics, Gynaecology and Maternal-Fetal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Upadhyaya
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
- King's College London School of Medicine, London, UK.
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17
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Biard JM, Payrat S, Clapuyt P, Barrea C, Benoit V, Baldin P, Bernard P, Van Grambezen B, Sznajer Y. Antenatal diagnosis of CHARGE syndrome: Prenatal ultrasound findings and crucial role of fetal dysmorphic signs. About a series of 10 cases and review of literature. Eur J Med Genet 2021; 64:104189. [PMID: 33662639 DOI: 10.1016/j.ejmg.2021.104189] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 12/25/2022]
Abstract
Although the prognosis of CHARGE syndrome can be highly variable from mild until severe, final diagnosis is difficult to establish in utero. The aim of our study is to compare antenatal and postnatal findings in a retrospective cohort of 10 successive patients with a positive CHD7 gene variant in order to identify the specific prenatal features for CHARGE syndrome diagnosis. Fetal ultrasound, follow-up and supplementary investigations are collected and compared to postnatal findings. Congenital heart defect (7/10), choanal atresia (7/10) and tracheoesophageal atresia (4/10) are the most frequent fetal anomalies found. Inner and external ear anomalies appear as the keystone (constant features) for prenatal diagnosis of CHARGE syndrome in fetuses with multiple anomalies and normal microarray karyotype. External ear malformations are identified in all cases by 3D ultrasound when carefully evaluated. MRI and temporal bone CT-Scan are second line useful tools to assess the diagnosis when looking for semicircular canal agenesis, arhinencephaly and/or choanal atresia. Before availability of prenatal exome sequencing in clinical routine, present findings lead to the recommendation that fetuses, with congenital heart defect (mainly septal and conotruncal), cleft lip/palate or unexplained polyhydramnios should carefully be screened for clues suggesting CHARGE syndrome using 2D and 3D ultrasound, MRI and temporal bone CT-Scan. When CHARGE syndrome is suspected with normal molecular karyotype, CHD7 gene sequencing must be offered.
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Affiliation(s)
- Jean-Marc Biard
- Fetal Medicine Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Stéphanie Payrat
- Fetal Medicine Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Philippe Clapuyt
- Pediatric Radiology Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Catherine Barrea
- Cardiopediatric Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | | | - Pamela Baldin
- Department of Anatomopathology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Pierre Bernard
- Fetal Medicine Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Bénédicte Van Grambezen
- Neonatal Intensive Care Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Yves Sznajer
- Center for Human Genetics, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
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18
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Bhalgat PS, Nabi F, Ray S. Aortopulmonary window: Clues to fetal diagnosis. Ann Pediatr Cardiol 2021; 14:247-248. [PMID: 34103873 PMCID: PMC8174642 DOI: 10.4103/apc.apc_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/08/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022] Open
Abstract
Being a planar structure, fetal diagnosis of aorto-pulmonary window poses great challenge. A few echocardiographic signs can help to clinch the diagnosis.
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Affiliation(s)
| | - Fazal Nabi
- Department of Pediatric, Jaslok Hospital, Mumbai, Maharashtra, India
| | - Sudeshna Ray
- Department of Gynecology, Jaslok Hospital, Mumbai, Maharashtra, India
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Abstract
Liver and biliary pathology in the neonate are rare and include a broad range of structural, neoplastic, infectious, genetic, and metabolic diseases. While most conditions present postnatally, antenatal detection is increasing given recent advances in antenatal imaging capabilities. In certain structural or obstructive liver diseases, antenatal detection now proves essential to help guide treatment and prevent morbidity. We review the epidemiology, pathophysiology, common antenatal diagnostic findings, and recommendations for surgical liver and biliary pathology in the neonate.
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Affiliation(s)
- Matthew P Shaughnessy
- Department of Surgery, Division of Pediatric Surgery, Yale University School of Medicine, 333 Cedar St., FMB 131, New Haven, CT 06510, USA
| | | | - Robert A Cowles
- Department of Surgery, Division of Pediatric Surgery, Yale University School of Medicine, 333 Cedar St., FMB 131, New Haven, CT 06510, USA.
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Chandraharan E, Hartopp R, Thilaganathan B, Coutinho CM. How to set up a regional specialist referral service for Placenta Accreta Spectrum (PAS) disorders? Best Pract Res Clin Obstet Gynaecol 2020; 72:92-101. [PMID: 32747327 DOI: 10.1016/j.bpobgyn.2020.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/22/2022]
Abstract
There has been an approximately fivefold increase in the incidence of placenta accreta spectrum (PAS) disorders during the last 30 years, believed to be secondary to increasing Caesarean section rates. PAS disorder is associated with significantly increased maternal morbidity and mortality worldwide. Antenatal diagnosis by foetal medicine teams that have a special expertise to diagnose PAS disorder by the use of ultrasound scan, and a dedicated, highly specialised multidisciplinary team (MDT) comprising surgeons who are skilled in complex pelvic surgery and obstetric anaesthetists who have an expertise in high-risk obstetric anaesthesia, supported by haematology, operating theatre, interventional radiology, midwifery, neonatology, high-dependency and intensive care teams have been recommended to improve maternal and perinatal outcomes. Setting up a specialist MDT regional referral service, PAS involves collaboration with all stakeholders, ensuring appropriate funding, developing MDT care pathways, continuously auditing patient outcomes and disseminating knowledge through research, innovation, education and publications.
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Affiliation(s)
- Edwin Chandraharan
- Global Academy of Medical Education & Training, Office 4, 219 Kensington High Street, Kensington, London, England, W8 6BD, UK.
| | - Richard Hartopp
- St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, England, SW 17 0QT, UK.
| | - Baskaran Thilaganathan
- St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, England, SW 17 0QT, UK.
| | - Conrado Milani Coutinho
- Ribeirão Preto Medical School, University of São Paulo, Campus Universitário S/N, Ribeirão Preto, SP, CEP: 14048-900, Brazil.
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Forci K, Alami MH, Bouaiti E, Slaoui M, Mdaghri Alaoui A, Thimou Izgua A. Prevalence of congenital malformations at the "les Orangers" maternity and reproductive health Hospital of Rabat: descriptive study of 470 anomalies. BMC Pediatr 2020; 20:272. [PMID: 32493258 PMCID: PMC7268369 DOI: 10.1186/s12887-020-02179-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital malformations are described in about 3% of live births and 20% of stillbirths in the industrialized countries. The prevalence of congenital anomalies in developing countries, including Morocco, is not well known at the national level. The aim of our study is to conduct a descriptive exploratory analysis of congenital malformations cases diagnosed at the "Les Orangers" Maternity and Reproductive Health Hospital in Rabat. METHODS We collected all the cases of congenital malformations diagnosed at the "Les Orangers" Maternity and Reproductive Health Hospital in Rabat, from January 1st, 2011 to June 31st, 2016. Data were reported on pre-established sheets and on a registry of malformations. Total and specific prevalences were calculated for each malformation. A principal component analysis (PCA) was then conducted followed by a Varimax rotation in order to identify the different associations of malformations in our series. RESULTS We registred 245 cases of congenital malformations out of a total of 43,923 recorded births; a prevalence of 5.58 per thousand births of which 19.2% were FDIU (fetal deaths in utero). A polymalformative syndrome was found in 26.5% of cases which makes a total number of 470 anomalies. The musculoskeletal anomalies predominate with a rate of 33%, followed by neurological abnormalities 18%, of whom 31% were hydrocephalus, 26.2% anencephaly, and 20.24% spina bifida. Malformations of the eye, ear, face and neck were described in 12% of the cases, while genetic abnormalities were observed in 8,5% of which 87.5% represented Down syndrome. The antenatal diagnosis of congenital malformations was performed in 28.6% of cases. CONCLUSIONS Our study provides a general overview of the epidemiological situation related to different types of congenital anomalies for a specific area in Morocco. It represents a database that should be complemented by other multicenter studies and the implementation of a national registry to determine the prevalence of congenital malformations at a national level.
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Affiliation(s)
- K. Forci
- Congenital anomalies research team, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, B.P: 174 Downtown-Rabat, Rabat, Morocco
| | - M. H. Alami
- Congenital anomalies research team, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, B.P: 174 Downtown-Rabat, Rabat, Morocco
- “Les Orangers” Maternity and Reproductive Health Hospital of Rabat, CHU IBN SINA, Rabat, Morocco
| | - E. Bouaiti
- Laboratory of biostatistics, clinical & epidemiological research, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V, Rabat, Morocco
| | - M. Slaoui
- Faculty of Medicine and Pharmacy of Rabat, University Mohamed V, Rabat, Morocco
| | - A. Mdaghri Alaoui
- Congenital anomalies research team, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, B.P: 174 Downtown-Rabat, Rabat, Morocco
- Dysmorphology Unit and Congenital Anomalies, Pediatric Department 2, HER, CHU IBN SINA, Rabat, Morocco
| | - A. Thimou Izgua
- Congenital anomalies research team, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, B.P: 174 Downtown-Rabat, Rabat, Morocco
- Center of consultations and external explorations, HER, CHU IBN SINA, Rabat, Morocco
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Kamla I, Kamgaing N, Billong S, Tochie JN, Tolefac P, de Paul Djientcheu V. Antenatal and postnatal diagnoses of visible congenital malformations in a sub-Saharan African setting: a prospective multicenter cohort study. BMC Pediatr 2019; 19:457. [PMID: 31766990 PMCID: PMC6876077 DOI: 10.1186/s12887-019-1831-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Visible congenital malformations (VCMs) are one of the principal causes of disability in the world. Prenatal diagnosis is a paramount mandatory integral part of the follow up of pregnancies with VCM of the foetus in high-income setting. We aimed to determine the incidence of prenatal diagnosis of VCMs in a low-resource setting with no policy on antenatal diagnosis of VCMs. METHODS We carried out a prospective cohort multicenter study from July 2015 to June 2016 in 10 randomly selected maternity units of Yaoundé, Cameroon. We enrolled all newborns with one or more detectable VCMs at birth. Variables studied were findings of the 1st, 2nd and 3rd trimesters' obstetrical ultrasound scans, in order to establish a concordance between the clinical and sonographic diagnoses of the VCMs and determine the frequency of antenatal diagnosis as well as the rate of medical abortion. RESULTS The incidence of VCMs was 9 per 1000 births. The main VCMs were malformations of the skeletal (4.3%), neurological (2.2%), and gastrointestinal (2.1%) systems. The sex ratio was 1.1. Among the malformed newborns, 37% were premature and in 18.5% the diagnosis of a VCM was confirmed after a therapeutic termination of pregnancy (following suggestive findings of a malformation on antenatal ultrasound scan). The prevalence of sonographic antenatal diagnosis of VCMs was 21%. Hydrocephalus was the most diagnosed VCM antenatally. The mean gestational age at which antenatal clinics were initiated was 15 ± 5 weeks. The mean number of obstetrical ultrasound scans performed was two. CONCLUSION The incidence of VCMs in our resource-limited setting is high and antenatal diagnosis rates are very low. Overall, our study emphasizes on the importance antenatal diagnosis of VCMs, often overlooked in our setting. The goal being to reduce maternal and foetal morbidity in a setting already burdened by a high maternal and neonatal mortality.
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Affiliation(s)
- Igor Kamla
- Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Science of University of Yaoundé I, Yaoundé, Cameroon
| | - Nelly Kamgaing
- Department of Pediatrics, Faculty of Medicine and Biomedical Science of University of Yaoundé I, Yaoundé, Cameroon
- Department of Pediatrics, University Hospital Centre, Yaoundé, Cameroon
| | - Serge Billong
- Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Science of University of Yaoundé I, Yaoundé, Cameroon
| | - Joel Noutakdie Tochie
- Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Science of University of Yaoundé I, Yaoundé, Cameroon
| | - Paul Tolefac
- Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Science of University of Yaoundé I, Yaoundé, Cameroon
| | - Vincent de Paul Djientcheu
- Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Science of University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurosurgery, Central Hospital, Yaoundé, Cameroon
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Rialon KL, Akinkuotu A, Fahy AS, Shelmerdine S, Traubici J, Chiu P. Management of ovarian lesions diagnosed during infancy. J Pediatr Surg 2019; 54:955-958. [PMID: 30795909 DOI: 10.1016/j.jpedsurg.2019.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively. METHODS A retrospective study was performed of ovarian lesions in children <1 year-old from 2000 to 2014. RESULTS Forty patients were identified. Twenty-eight (70%) underwent operative management, while 12 (30%) were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%) had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid-fluid or fluid-debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm) and were followed for an average of 153 days until resolution. CONCLUSIONS The majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed. LEVEL OF EVIDENCE IIC.
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Affiliation(s)
- Kristy L Rialon
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adesola Akinkuotu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aodhnait S Fahy
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Shelmerdine
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Traubici
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Priscilla Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Visuri S, Jahnukainen T, Kivisaari R, Taskinen S. Reduced differential renal function in scintigraphy predicted high-grade vesicoureteral reflux in children with antenatal hydronephrosiss. Acta Paediatr 2019; 108:751-756. [PMID: 30113092 DOI: 10.1111/apa.14536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023]
Abstract
AIM A top-down approach is widely used for detecting vesicoureteral reflux (VUR) in children with febrile urinary tract infections. We evaluated the diagnostic value of renal scintigraphy in predicting VUR in children with antenatal hydronephrosis (AHN). METHODS The voiding cystourethrogram (VCUG) and renal scintigraphy results of 125 AHN patients (76% male) admitted to the Children's Hospital of Helsinki University, Finland, from 2003 to 2013 were analysed. Of those, 94 had nonrefluxing hydronephrosis, nine had low-grade VUR and 22 had high-grade VUR. RESULTS Scintigraphy was performed at a median age of 1.4 (0.8-15.6) months. In patients with high-grade VUR, the differential renal function (DRF) of the worse kidney was significantly lower than in patients without VUR, with a median of 35% and interquartile range (IQR) of 20-45 versus 47% (IQR: 44-49), (p < 0.001). There was no difference between patients with low-grade VUR and patients without VUR (p = 0.181). DRFs below 44% showed a sensitivity of 73% and specificity of 79% and predicted significantly high-grade VUR (odds ratio 9.82, 95% confidence interval 3.44-28.05, p < 0.001) in the univariate analysis. CONCLUSION A DRF below 44% predicted high-grade VUR in patients with AHN and supported the decision to perform VCUG.
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Affiliation(s)
- Sofia Visuri
- University of Helsinki; Helsinki Finland
- Department of Pediatric Surgery; Uppsala University Children's Hospital; Uppsala Sweden
- Department of Pediatric Surgery; Helsinki University Hospital; Helsinki Finland
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - Reetta Kivisaari
- Department of Pediatric Radiology; Helsinki University Hospital; Helsinki Finland
| | - Seppo Taskinen
- Department of Pediatric Surgery; Helsinki University Hospital; Helsinki Finland
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Arcus C, Sennaiyan U, Trivedi A, Alahakoon TI. Antenatal ultrasound diagnosis of small bowel non-rotation in complex left isomerism: a case report. Int J Surg Case Rep 2019; 56:32-36. [PMID: 30822676 PMCID: PMC6393701 DOI: 10.1016/j.ijscr.2018.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022] Open
Abstract
A rare case of mixed isomerism and antenatally diagnosed non-rotation of bowel is reported. Features of bowel non-rotation should be sought antenatally in cases of isomerism. Mixed isomerism and postnatal sequelae should be considered when right and left sided pathology coexist.z
Presentation of case A multiparous expectant mother was referred to our tertiary unit at 23 weeks with a complex fetal cardiac anomaly in the context of suspected heterotaxy syndrome. The cardiac findings were consistent with isomerism: the fetal cardiac position was levocardia with a single functioning double outlet ventricle and AV valve, pulmonary stenosis, and interrupted inferior vena cava (IVC) with azygous continuation. The fetal abdominal situs was also altered, with the stomach to the right, and the hepatobiliary system midline to left. The spleen was not identified antenatally or postnatally. At 36 weeks, ultrasound revealed an abnormal bowel pattern with small bowel loops on the right side of the abdomen and large bowel on the left, suggesting a diagnosis of non- rotation. The infant was delivered vaginally at 39 weeks. The cardiac diagnosis and non-rotation of the small bowel were confirmed by postnatal echocardiography and contrast fluoroscopy. Discussion Heterotaxy syndrome is traditionally classified into right or left isomerism depending on how and where the organs are anatomically arranged. The case presented here demonstrates mixed laterality and prenatal ultrasound features of non-rotation. Conclusion It is important to be informed of the embryological variants of isomerism and actively seek antenatal evidence of bowel non-rotation in such cases.
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Affiliation(s)
- Charles Arcus
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, NSW, 2145, Australia; The University of Sydney, Sydney Medical School, Sydney, NSW, Australia.
| | - Usha Sennaiyan
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, NSW, 2145, Australia
| | - Amit Trivedi
- Grace Centre for Newborn Care, Westmead Children's Hospital, Sydney, NSW, 2145, Australia.
| | - Thushari I Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, NSW, 2145, Australia; The University of Sydney, Sydney Medical School, Sydney, NSW, Australia.
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Yhoshu E, Mahajan JK, Singh UB. Choroid plexus cysts-antenatal course and postnatal outcome in a tertiary hospital in North India. Childs Nerv Syst 2018; 34:2449-53. [PMID: 30009327 DOI: 10.1007/s00381-018-3913-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the gestational course and postnatal outcome of antenatally diagnosed choroid plexus cysts. METHODS From January 2015 to October 2017, mothers carrying foetuses with choroid plexus cysts (CPCs) were followed up prospectively till delivery, and subsequent postnatal assessment of all the babies was done. Progress of the lesions was monitored during pregnancy with ultrasound (USG) scans and postnatally analysed with clinical assessment and USG examination of the cranium. RESULTS A total of 67 mothers of antenatally diagnosed CPCs were referred to the Paediatric Surgery Unit for opinion. Mean gestational age at the time of diagnosis was 19 ± 2.1 weeks (17-28 weeks) while mean age of the mothers at the time of referral was 26 ± 3.3 years (19-35 years). Sixty four mothers have undergone repeat antenatal scans after the diagnosis, and the CPCs disappeared completely in 60 (93.8%) of them. The CPCs persisted but reduced in size in 2 (4.1%), and the other 2 have been lost to follow-up. Thirty eight patients (56.7%) have unilateral CPCs. Mean size of cysts is 6.08 ± 3.0 mm (2.4‑14.8 mm). One foetus, in which the CPC disappeared antenatally, developed it again on the postnatal scans, but is doing well on follow-up. Thirteen babies (19.4%) have other associated congenital malformations as well. CONCLUSIONS CPCs may involve one or both ventricles and disappear in approximately 95% of the cases, mostly within 2 months from the diagnosis. The size of the cyst has no relation to its rate of disappearance. Postnatal persistence of CPCs is uncommon and the neurological sequel is unlikely; hence, prospective parents should be reassured accordingly.
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Abstract
In today's era of improved antenatal care and screening modalities (3D high-resolution fetal ultrasound, fetal magnetic resonance imaging, fetal echocardiography, maternal serum markers and fetal blood sampling), an early diagnosis of surgical fetal abnormalities is routinely possible. A thorough knowledge about the incidence of such defects, the means of detection and evaluation, the scope of fetal intervention, postnatal management and long-term outcomes of common surgical conditions diagnosed antenatally is essential. This knowledge would not only help in proper patient care and management but also to ensure appropriate counselling of the expectant parents. This article highlights the fetal anomalies which are amenable to some form of fetal intervention from a pediatric surgical perspective as also those which can be treated after birth.
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Affiliation(s)
- Kashish Khanna
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Anjan Kumar Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
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28
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Arena S, Chimenz R, Antonelli E, Peri FM, Romeo P, Impellizzeri P, Romeo C. A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function. Eur J Pediatr 2018; 177:1761-1765. [PMID: 30209594 DOI: 10.1007/s00431-018-3239-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/24/2018] [Accepted: 08/31/2018] [Indexed: 02/01/2023]
Abstract
The aim of the study was to retrospectively review the outcome of neonatal ureteropelvic junction obstruction with a good renal function and a poor drainage at a first diuretic renal scan, in cases where surgery was recommended on the basis of a loss of renal function, worsening of hydronephrosis or occurrence of clinical symptoms. Hydronephrosis was graded from 1 to 4 or as ureteral tract dilatation (UTD) P1 to UTD P3. During follow-up, 15 out of 38 patients (34.2%) required surgery while 25 out of 38 (65.8%) could have been managed conservatively. In patients with grade 2, 3, and 4 hydronephrosis, the ureteropelvic junction obstruction resolved or improved spontaneously in 100%, 63%, and 33% of cases (in 100% of UTD P1, 67% of UTD P2, and 50% of UTD P3), respectively. The median of follow-up was 14 years. Chi-square test showed a significant relationship between initial grade of hydronephrosis or UTD and the possibility of an efficient conservative management (p = 0.0088 and p = 0.0460).Conclusion: Conservative management can be safely achieved in ureteropelvic junction obstruction with poor drainage. Scheduled controls are needed for early discovery of functional renal deterioration. High-grade hydronephrosis is unlikely to resolve spontaneously and is often accompanied by a loss of renal function during the first years of life. What is Known: • There is controversy about which management should be adopted in infants with unilateral ureteropelvic junction obstruction with poor drainage but good differential renal function. What is New: • Long-term follow-up suggests that conservative management can be safely achieved also in unilateral ureteropelvic junction obstruction with poor drainage in more than 60% of cases, even if high-grade hydronephrosis is unlikely to resolve spontaneously and it is often accompanied by a loss of renal function during the first years of life. In our experience, surgical intervention was required in more than 50% of cases before 1 year of life and in all cases before 3 years of life.
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Affiliation(s)
- S Arena
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy.
| | - R Chimenz
- Unit of Pediatric Nephrology, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - E Antonelli
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - F M Peri
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - P Romeo
- Catholic University of Rome, Rome, Italy
| | - P Impellizzeri
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - C Romeo
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
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29
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Hureaux M, Molin A, Jay N, Saliou AH, Spaggiari E, Salomon R, Benachi A, Vargas-Poussou R, Heidet L. Prenatal hyperechogenic kidneys in three cases of infantile hypercalcemia associated with SLC34A1 mutations. Pediatr Nephrol 2018; 33:1723-1729. [PMID: 29959532 DOI: 10.1007/s00467-018-3998-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prenatal diagnosis of hyperechogenic kidneys is associated with a wide range of etiologies and prognoses. The recent advances in fetal ultrasound associated with the development of next-generation sequencing for molecular analysis have enlarged the spectrum of etiologies, making antenatal diagnosis a very challenging discipline. Of the various known causes of hyperechogenic fetal kidneys, calcium and phosphate metabolism disorders represent a rare cause. An accurate diagnosis is crucial for providing appropriate genetic counseling and medical follow-up after birth. METHODS We report on three cases of fetal hyperechogenic kidneys corresponding to postnatal diagnosis of nephrocalcinosis. In all cases, antenatal ultrasound showed hyperechogenic kidneys of normal to large size from 22 gestational weeks, with a normal amount of amniotic fluid. Postnatal ultrasound follow-up showed nephrocalcinosis associated with hypercalcemia, hypercalciuria, elevated 1,25(OH)2-vitamin D, and suppressed parathyroid hormone levels. RESULTS Molecular genetic analysis by next-generation sequencing performed after birth in the three newborns revealed biallelic pathogenic variants in the SLC34A1 gene, encoding the sodium/phosphate cotransporter type 2 (Npt2a), confirming the diagnosis of infantile hypercalcemia. CONCLUSIONS Nephrocalcinosis due to infantile hypercalcemia can be a cause of fetal hyperechogenic kidneys, which suggests early antenatal anomaly of calcium and phosphate metabolism. This entity should be considered in differential diagnosis. Postnatal follow-up of infants with hyperechogenic kidneys should include evaluation of calcium and phosphate metabolism.
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Affiliation(s)
- Marguerite Hureaux
- Département de Génétique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Filière ORKiD, Paris, France
| | - Arnaud Molin
- Service de Génétique, Centre Hospitalier Universitaire de Caen, Caen, France.,Centre de Référence des Maladies rares du Métabolisme du calcium et du phosphate (filière OSCAR), FilièreOSCAR, Paris, France.,Université Caen Normandie, UFR de médecine (Medical School), EA7450 BioTarGen, Caen, France
| | - Nadine Jay
- Centre Hospitalier Universitaire de Brest, Service de Pédiatrie et Génétique Médicale, Brest, France
| | | | - Emmanuel Spaggiari
- Département de Gynécologie-Obstétrique, Assistance Publique Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Paris, France
| | - Rémi Salomon
- Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Filière ORKiD, Paris, France.,Département de Néphrologie Pédiatrique, Assistance Publique Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Paris, France
| | - Alexandra Benachi
- Département de Gynécologie-Obstétrique, Assistance Publique Hôpitaux de Paris, Hôpital Antoine-Béclère, Université Paris-Sud, Clamart, France
| | - Rosa Vargas-Poussou
- Département de Génétique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France. .,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Filière ORKiD, Paris, France.
| | - Laurence Heidet
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Filière ORKiD, Paris, France.,Département de Néphrologie Pédiatrique, Assistance Publique Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Paris, France
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30
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Deshpande AV. Current strategies to predict and manage sequelae of posterior urethral valves in children. Pediatr Nephrol 2018; 33:1651-1661. [PMID: 29159472 DOI: 10.1007/s00467-017-3815-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
Posterior urethral valves (PUV) constitute a significant urological cause of chronic kidney disease (CKD) in children. The condition is characterised by the unique pathophysiology of the evolution of bladder dysfunction after relief of obstruction, which contributes to CKD. Improvements in prenatal diagnosis followed by selective foetal intervention have not yet produced improvement in long-term renal outcomes, although better patient selection may alter this in the future. Proactive management with surveillance, pharmacotherapy, timed voiding, double voiding, and/or assisted bladder-emptying, is being increasingly offered to those with severe bladder dysfunction and has the potential of reducing the burden of renal disease. Clinicians are currently able to counsel regarding the prognosis using serum creatinine and other emerging markers. However, much of this work remains to be validated. Satisfactory graft survival rates are now reported with aggressive management of bladder dysfunction in children who are candidates for renal transplantation. Knowledge gaps exist in identifying early markers of renal injury, risk stratification, and in understanding patient and carer perspectives in PUV.
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Affiliation(s)
- Aniruddh V Deshpande
- Department of Paediatric Urology and Surgery, John Hunter Children's Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia. .,Priority Research Centre GrowupWell, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
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31
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Antomarchi J, Moeglin D, Laurichesse H, Combourieu D, Bigi N, Maisonneuve E, Legac P, Althuser M, Delotte J, Jouannic JM, Bongain A. The Pubic Diastasis Measurement, a Key Element for the Diagnosis, Management, and Prognosis of the Bladder Exstrophy. Fetal Diagn Ther 2018; 45:435-440. [PMID: 30231253 DOI: 10.1159/000492817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of measuring the fetal pubic diastasis (PD) distance on antenatal ultrasound in normal fetuses and to compare it to fetuses with bladder exstrophy. METHODS Firstly, a prospective multicentric study was conducted to determine the feasibility of the PD ultrasound measurement during the second half of pregnancy. Secondly, data from a single center were used to develop a nomogram for PD values in normal fetuses. Thirdly, retrospective PD measurements were collected from fetuses with bladder exstrophy, diagnosed in seven French Multidisciplinary Centers for Prenatal Diagnosis (MCPDs). RESULTS Operators from several MCPDs examined 868 fetuses and found that overall PD ultrasound measurement was feasible in 71% of cases and that the ossification of pubic points increased to be always visible from 27 weeks of gestation onward. Performed in a single center by a referring operator on 1,539 fetuses, the feasibility reached 94.74%. Both set of measurements were concordant (mean PD distance value of 5.42 ± 1.8 mm). Interestingly, all 23 fetuses with bladder exstrophy showed a significantly larger PD distance (mean 15.74 ± 3.9 mm). CONCLUSION PD measurement in the fetus is feasible and reliable in the second half of gestation and can be used to support the antenatal diagnosis of bladder exstrophy with PD values exceeding 10 mm.
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Affiliation(s)
- Julie Antomarchi
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France,
| | - Daniel Moeglin
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
| | | | - Danièle Combourieu
- Hôpital Femme-Mère-Enfants, Centre Pluridisciplinaire Diagnostic Prénatal, Lyon-Bron, France
| | - Nicole Bigi
- CRHU Carémeau-Nîmes, Service Gynécologie Obstétrique, Nîmes, France
| | - Emeline Maisonneuve
- Université Pierre et Marie Curie, Hôpital Armand-Trousseau, Service de Médecine Fœtale, Paris, France
| | - Pascale Legac
- CRHU Carémeau-Nîmes, Service Gynécologie Obstétrique, Nîmes, France
| | - Marc Althuser
- CHU Grenoble, Centre de Diagnostic Prénatal, Grenoble, France
| | - Jérome Delotte
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
| | - Jean-Marie Jouannic
- Université Pierre et Marie Curie, Hôpital Armand-Trousseau, Service de Médecine Fœtale, Paris, France
| | - André Bongain
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
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Melov SJ, Tsang I, Cohen R, Badawi N, Walker K, Soundappan SSV, Alahakoon TI. Complexity of gastroschisis predicts outcome: epidemiology and experience in an Australian tertiary centre. BMC Pregnancy Childbirth 2018; 18:222. [PMID: 29890949 PMCID: PMC5996507 DOI: 10.1186/s12884-018-1867-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/30/2018] [Indexed: 01/18/2023] Open
Abstract
Background Gastroschisis is a congenital anomaly of the fetal abdominal wall, usually to the right side of umbilical insertion. It is often detected by routine antenatal ultrasound. Significant maternal and pediatric resources are utilised in the care of women and infants with gastroschisis. Increasing rates of gastroschisis worldwide have led institutions to review local data and investigate outcomes. A collaborative project was developed to review local epidemiology and investigate antenatal and neonatal factors influencing hospital length of stay (LOS) and total parental nutrition (TPN) in infants born with gastroschisis. Methods We performed a five-year review of infants born with gastroschisis (2011–2015) at a major Australian centre. Complex gastroschisis was defined as involvement of stenosis, atresia, ischemia, volvulus or perforation and closed or vanishing gastroschisis. We extracted data from files and databases at the two participating hospitals, a major maternal fetal medicine centre and the affiliated children’s hospital. Results There were 56 infants antenatally diagnosed with gastroschisis with no terminations, one stillbirth (2%) and one infant with ‘vanishing’ gastroschisis. The mean maternal age was 23.9 years (range, 15–39 years). The mean gestation at delivery was 36 weeks (range, 25–39+ 3 weeks). Of the 55 neonates who received surgical management, 62% had primary closure. The median LOS was 33 (IQR, 23–45) days and the median duration of TPN was 26 (IQR, 17–36) days. Longer days on TPN (median 35 vs 16 days, P = 0.03) was associated with antenatal finding of multiple dilated bowel loops. Postnatal diagnosis of complex gastroschisis was made in 16% of cases and was associated with both longer LOS (median 89 vs 30 days, P = 0.003) and days on TPN (median 46 vs 21 days, P = 0.009). Conclusion Complex gastroschisis was associated with greater days on TPN and LOS. We found no late-gestation stillbirths and a low overall rate of 1.8%, suggesting the risk for stillbirth associated with gastroschisis is lower than previously documented. This information may assist counselling families. Improved data collection worldwide may reveal causative factors and enable antenatal outcome predictors.
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Affiliation(s)
- Sarah J Melov
- Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Research & Education Network Building, Hawkesbury Rd, PO Box 533, Westmead, NSW, 2145, Australia.
| | - Irene Tsang
- Department of Paediatric Surgery, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, NSW, 2145, Australia
| | - Ralph Cohen
- Department of Paediatric Surgery, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, Wentworthville, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, NSW, Australia
| | - Karen Walker
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, Wentworthville, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, NSW, Australia
| | - Soundappan S V Soundappan
- Department of Paediatric Surgery, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Thushari I Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Research & Education Network Building, Hawkesbury Rd, PO Box 533, Westmead, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia
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Woodbury JM, Bojanić K, Grizelj R, Cavalcante AN, Donempudi VK, Weingarten TN, Schroeder DR, Sprung J. Incidence of congenital diaphragmatic hernia in Olmsted County, Minnesota: a population-based study. J Matern Fetal Neonatal Med 2017; 32:742-748. [PMID: 28992719 DOI: 10.1080/14767058.2017.1390739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The rate of congenital diaphragmatic hernia (CDH) varies, but most reports estimate the incidence to be less than three per 10,000 births. Our objective was to document the incidence of CDH in a geographically well-defined population using available resources for highly accurate incident case ascertainment. METHODS We ascertained CDH cases in Olmsted County, Minnesota, United States of America, from 1981 through 2014 using resources of the Rochester Epidemiology Project. Overall and sex-specific incidence rates were calculated, and hospital survival was assessed. RESULTS A total of 26 incident CDH cases were identified; the overall incidence of 3.6 (95% CI, 2.2-5.0) per 10,000 did not differ significantly over the 34-year study period (p = .28). The estimated incidence was 4.3 (95% CI, 2.2-6.5) for male infants and 2.9 (95% CI, 1.1-4.6) for female infants. The percentage of cases diagnosed prenatally was 33% from 1981 through 2000 and 50% from 2001 through 2014. The rate of survival to discharge in the two periods was 50% and 88%. CONCLUSION The incidence of CDH in Olmsted County exceeds the majority of published rates, which most likely can be attributed to our comprehensive case ascertainment.
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Affiliation(s)
- Jason M Woodbury
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
| | - Katarina Bojanić
- b Division of Neonatology, Department of Obstetrics and Gynecology , University Hospital Merkur , Zagreb , Croatia
| | - Ruža Grizelj
- c Department of Pediatrics , University of Zagreb, School of Medicine, University Hospital Centre Zagreb , Zagreb , Croatia
| | - Alexandre N Cavalcante
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
| | - Vinay K Donempudi
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
| | - Toby N Weingarten
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
| | - Darrell R Schroeder
- d Division of Biomedical Statistics and Informatics , Mayo Clinic , Rochester , MN , USA
| | - Juraj Sprung
- a Department of Anesthesiology and Perioperative Medicine , Mayo Clinic , Rochester , MN , USA
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Abstract
Management of congenital diaphragmatic hernia (CDH) begins soon after it is detected, whether antenatally or postnatally. Assessment of the severity of the condition, associated congenital anomalies, maternal health and related issues, weight of the fetus/baby, mode of delivery, timing of delivery, immediate appropriate management of the baby with CDH at birth, appropriate utilization of available treatment modalities as well as infrastructure of the treating institute have an impact on the outcome of the neonate. Survival without significant long-term/permanent morbidity is considered as good outcome. With advances in antenatal diagnosis, several legal and ethical considerations have cropped up. While on one hand there are proponents of early antenatal diagnosis and medical termination of pregnancy (MTP), on the other hand there are several socio-cultural groups who look upon human life as precious and argue against MTP. There is an ongoing ethical battle between maternal vs. fetal rights; there is no way to put a lid on the controversy whether the mother be allowed to choose in favor of MTP after being aware of the anomalous fetus or, we must attempt to save every fetus irrespective of the antenatal diagnosis of life-threatening anomalies. Notwithstanding, appropriate assessment of the condition, thorough counseling and sound evidence-based decisions could avert ethical dilemma in most cases. This review article provides information about the various choices available in the diagnostic and treatment armamentarium, though it should be kept in mind that the entire spectrum of management strategies may not be universally available.
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Affiliation(s)
- Sushmita Nitin Bhatnagar
- Department of Pediatric Surgery, B.J.Wadia Hospital for Children, Parel, Mumbai, Maharashtra, 400012, India.
| | - Yogesh Kumar Sarin
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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35
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Avitan T, Drukker L, Pri-Chen H, Rabinowitz R, Algur N, Schimmel MS, Schreiber L, Bdolah-Abram T, Samueloff A, Grisaru-Granovsky S. Fetal Urine Production Rate in Preterm Premature Rupture of Membranes Is Associated with Adverse Neonatal Outcome: A Pilot Study. Gynecol Obstet Invest 2017; 83:57-64. [PMID: 28715801 DOI: 10.1159/000478778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/19/2017] [Indexed: 11/19/2022]
Abstract
AIM In this study, we evaluate the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). METHODS We conducted a prospective pilot cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later managed until spontaneous labor (after 48 h of admission), chorioamnionitis, or induction by protocol at 35 + 0 weeks. FUPR was evaluated by 2D sonography at admission (corrected for gestational age). The main neonatal outcome measures were chorioamnionitis, placental inflammatory grading, first neonatal creatinine value, first neonatal dextrose value, length of neonatal intensive care unit (NICU) stay, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grades I-IV), blood transfusions, reduced neonatal urine production rate (<4 mL/kg/h), and early neonatal sepsis. Samples of maternal (at admission) and umbilical cord blood were analyzed for interleukin-6 (IL-6) level. RESULTS The study included 38 women. Low FUPR was associated with clinical chorioamnionitis, longer NICU hospitalization (p = 0.01), higher rates of NEC or IVH (p = 0.008), and blood transfusion (p = 0.004). CONCLUSIONS A finding of FUPR on in utero ultrasound examination in pregnancies complicated by PPROM may be indicative of adverse neonatal outcome.
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Affiliation(s)
- Tehila Avitan
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School, Jerusalem, Israel
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van den Eijnden MHA, de Kleine RH, de Blaauw I, Peeters PMJG, Koot BGP, Oomen MWN, Sloots CEJ, van Gemert WG, van der Zee DC, van Heurn LWE, Verkade HJ, Wilde JCH, Hulscher JBF. The timing of surgery of antenatally diagnosed choledochal malformations: A descriptive analysis of a 26-year nationwide cohort. J Pediatr Surg 2017; 52:1156-1160. [PMID: 28318597 DOI: 10.1016/j.jpedsurg.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/23/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Choledochal malformations (CMs) are increasingly diagnosed antenatally. There is a dilemma between early surgery to prevent CM-related symptoms and postponing surgery to reduce complications. We aimed to identify the optimal timing of surgery in asymptomatic neonates with antenatally diagnosed CM and to identify predictors for development of symptoms. METHODS Using the Netherlands Study group on CHoledochal Cyst/malformation (NeSCHoc) we retrospectively collected demographic, biochemical and surgical data from all Dutch patients with an antenatally detected CM. RESULTS Between 1989 and 2014, antenatally suspected CM was confirmed in 17 patients at a median age of 10days (1day-2months). Four patients developed symptoms directly after birth (24%). Thirteen patients (76%) remained asymptomatic. Two of these progressed to symptoms before surgical intervention at 0.7 and 2.1months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients <5.6kg (the series median) showed more short-term complications (66%) when compared to patients >5.6kg (0%, p=0.02). CONCLUSION When not symptomatic within the first days of life, the majority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6months or a weight of 6kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
| | - Maria H A van den Eijnden
- Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Paul M J G Peeters
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart G P Koot
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Matthijs W N Oomen
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Cornelius E J Sloots
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wim G van Gemert
- Department of Pediatric Surgery, University Medical Center Maastricht, Maastricht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Henkjan J Verkade
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jim C H Wilde
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Jan B F Hulscher
- Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Bernheim S, Deschênes G, Schiff M, Cussenot I, Niel O. Antenatal nephromegaly and propionic acidemia: a case report. BMC Nephrol 2017; 18:110. [PMID: 28359305 PMCID: PMC5372311 DOI: 10.1186/s12882-017-0535-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 03/25/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Propionic acidemia (PA) is a rare but severe recessive autosomal disease, presenting with non specific signs in the first years of life. Prenatal diagnosis is invasive (amniocentesis) and limited to suspect cases. No screening test has been described, in particular no correlations between prenatal sonography and PA have been documented so far. CASE PRESENTATION We report the case of a boy with fetal bilateral nephromegaly and hyperechogenic kidneys, along with neonatal acute kidney injury; no etiology could be found in the first months of life. At 3 months of life, he presented with tachypnea and altered mental status, which lead to the diagnosis of PA. The renal ultrasound at 8 months of life, after a symptomatic treatment of PA had been initiated, showed a regression of the renal abnormalities. CONCLUSION This case describes PA as a novel cause of large and hyperechogenic kidneys in the antenatal period. It suggests that, when confronted to fetal nephromegaly, hyperechogenic kidneys and risk factors of metabolic disease such as consanguineous parents, PA should be considered, and a prenatal test should be proposed.
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Affiliation(s)
- Ségolène Bernheim
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.
| | - Georges Deschênes
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,Paris Diderot University, Paris, France
| | - Manuel Schiff
- Metabolic Diseases Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,Paris Diderot University, Paris, France
| | - Isabelle Cussenot
- Radiology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Olivier Niel
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.,Molecular Bases of Hereditary Kidney Diseases, Inserm U1163 - Sorbonne Paris Cité - Paris Descartes University, 24 boulevard du Montparnasse, 75015, Paris, France.,Paris Diderot University, Paris, France
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38
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Abstract
AIM To analyze the impact of counseling on antenatal congenital surgical anomalies (ACSA). METHODS Cases presenting with ACSA for fetal counseling and those presenting in post-natal period following diagnosis of ACSA (PACSA) for surgical opinion were analyzed for spectrum, presentation and outcome. RESULTS 117 cases including ACSA(68);PACSA(49) were analyzed. Gestational age at diagnosis of ACSA;PACSA was 17-37;17-39 weeks (median 24;32 weeks). Diagnoses in ACSA;PACSA included urological (26;31), neurological (10;5), congenital diaphragmatic hernia (CDH)(5;1), gastrointestinal (5;5), lung and chest anomalies (5;1), intraabdominal cysts (4;1), abdominal wall defects (4;0), tumors (3;3), limb anomaly (1;1), esophageal atresia (1;1), conjoint twins (1;0), hepatomegaly (1;0), and major cardiac anomalies (2;0). Two antenatal interventions were done for ACSA; vesicoamniotic shunt and amnioinfusion for oligohydramnios. 17;24 ACSA;PACSA required early surgical intervention in post-natal period. Nine ACSA underwent medical termination of pregnancy and 4 had intrauterine demise. Nine ACSA babies died including two CDH, one gastroschisis, one duodenal atresia, one conjoint twins, one megacystitis with motility disorder and three posterior urethral valves. All PACSA babies survived. CONCLUSION Fetal counseling for CSA portrays true outcome of ACSA with 32.3% (22/68) mortality versus 0% for PACSA due to selection bias. However, fetal counseling ensures optimal perinatal care.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ranjana Bhanot
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Dipika Deka
- Department of Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Carlsson T, Bergman G, Karlsson AM, Wadensten B, Mattsson E. Experiences of termination of pregnancy for a fetal anomaly: A qualitative study of virtual community messages. Midwifery 2016; 41:54-60. [PMID: 27543968 DOI: 10.1016/j.midw.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly. DESIGN cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis. SETTING two large and active Swedish virtual communities. SAMPLE 1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination). MEASUREMENTS AND FINDINGS before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child. KEY CONCLUSIONS spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences. IMPLICATIONS FOR PRACTICE information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies.
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Affiliation(s)
- Tommy Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden.
| | - Gunnar Bergman
- Department of Women's and Children's Health, Karolinska Institutet, SE-17176, Stockholm, Sweden
| | - Anna-Malin Karlsson
- Department of Scandinavian Languages, Uppsala University, SE-75120, Uppsala, Sweden
| | - Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden
| | - Elisabet Mattsson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75122, Uppsala, Sweden; Department of Health Care Sciences, Ersta Sköndal University College, SE-10061, Stockholm, Sweden
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Versteegh HP, Adams SD, Boxall S, Burge DM, Stanton MP. Antenatally diagnosed right-sided stomach (dextrogastria): A rare rotational anomaly. J Pediatr Surg 2016; 51:236-9. [PMID: 26655213 DOI: 10.1016/j.jpedsurg.2015.10.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 02/04/2023]
Abstract
AIM Antenatal detection of right-sided stomach (dextrogastria) is rare, and its significance in regards to intestinal rotation is unclear. We aimed to review all cases of antenatally-diagnosed dextrogastria in our regional fetal medicine unit over 10years. METHODS A retrospective case-note review of patients identified from a prospectively-maintained database was performed. RESULTS Twenty cases of antenatally-diagnosed dextrogastria were identified from 2004 to 2014. There were 8 terminations and 1 intra-uterine death. One patient has no post-natal information obtainable. Ten infants were live-born, and 2 died secondary to cardiac disease in the neonatal period. All had significant cardiac/vascular anomaly on postnatal assessment, including the 3 neonates in whom dextrogastria was the only antenatal finding. Two neonates developed bilious vomiting and underwent Ladd's procedure. Operative findings were dextrogastria/malrotation in both. A third child had gastro-oesophageal reflux, and contrast demonstrated stable duodenal/midgut position. This child has not developed symptoms attributable to malrotation and not undergone surgery. All 3 of these infants had asplenia or polysplenia and were managed with antibiotic prophylaxis/immunisation. Five children in the series were not investigated for malrotation and have not come to surgical attention (one is known to be asplenic). CONCLUSION Antenatally-detected dextrogastria, even if apparently isolated, was always associated with postnatal significant cardiovascular anomaly, splenic abnormality or situs inversus. This may be important for antenatal counselling. We currently recommend postnatal echocardiography and splenic assessment, but reserve GI investigation/intervention for symptomatic malrotation owing to potential significant cardiac comorbidity.
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Affiliation(s)
- Hendt P Versteegh
- Department of Paediatric Surgery, University Hospital Southampton Foundation NHS Trust
| | - Stephen D Adams
- Department of Paediatric Surgery, University Hospital Southampton Foundation NHS Trust
| | - Sally Boxall
- Department of Fetal Medicine,University Hospital Southampton Foundation NHS Trust
| | - David M Burge
- Department of Paediatric Surgery, University Hospital Southampton Foundation NHS Trust
| | - Michael P Stanton
- Department of Paediatric Surgery, University Hospital Southampton Foundation NHS Trust.
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Nohuz E, Boulay E, Albaut M, Nkoy DF, Laurichesse-Delmas H, Lemery D, Gallot D, Vendittelli F. [How I do… the antenatal diagnosis of a vasa previa with ultrasound]. ACTA ACUST UNITED AC 2015; 43:619-22. [PMID: 26297157 DOI: 10.1016/j.gyobfe.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- E Nohuz
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, BP 89, route du Fau, 63300 Thiers, France; EA 4681, PEPRADE, Clermont université, université d'Auvergne, Clermont-Ferrand, France.
| | - E Boulay
- EA 4681, PEPRADE, Clermont université, université d'Auvergne, Clermont-Ferrand, France
| | - M Albaut
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, BP 89, route du Fau, 63300 Thiers, France
| | - D-F Nkoy
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, BP 89, route du Fau, 63300 Thiers, France
| | - H Laurichesse-Delmas
- EA 4681, PEPRADE, Clermont université, université d'Auvergne, Clermont-Ferrand, France; Pôle gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - D Lemery
- EA 4681, PEPRADE, Clermont université, université d'Auvergne, Clermont-Ferrand, France; Pôle gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - D Gallot
- Pôle gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; R2D2-EA 7281, faculté de médecine, Clermont université, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - F Vendittelli
- EA 4681, PEPRADE, Clermont université, université d'Auvergne, Clermont-Ferrand, France; Pôle gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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42
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Evans K, Asimakadou M, Nwankwo O, Desai D, Cherian A, Mushtaq I, Cuckow P, Duffy P, Smeulders N. What is the risk of urinary tract infection in children with antenatally presenting dilating vesico-ureteric reflux? J Pediatr Urol 2015; 11:93.e1-6. [PMID: 25819378 DOI: 10.1016/j.jpurol.2015.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/15/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The incidence of recurrent urinary tract infection (UTI) in children with primary vesico-ureteric reflux (VUR) presenting symptomatically is well documented. The risk of UTI in asymptomatic primary VUR diagnosed on investigation of antenatal hydronephrosis (ANH) is less clear. Paradoxically, several previous studies have suggested a lower risk (1-25%). We ascertain the incidence of UTI amongst antenatally-presenting primary VUR and explore risk factors. STUDY DESIGN All patients <16 years managed for primary VUR between 1997 and 2013 were retrospectively reviewed. Patients were identified by searching 'VUR, vesicoureteric reflux' and 'vesico' in the clinical database. Sex, follow up, antibiotic prophylaxis, age at UTI, grade of VUR, radioisotope imaging findings (CRN-congenital reflux nephropathy, NRD-new renal defects), evidence of bladder dysfunction, surgical intervention and resolution were recorded. UTI diagnosis was based on positive urine culture with symptoms including fever. SPSS statistical package and Pearson's Chi-squared test were used to explore significance. RESULTS Of 308 patients with primary VUR aged <16 years treated, 242 were diagnosed following presentation with UTI. The remaining 66 (21%) were initially asymptomatic, and VUR was diagnosed on investigation of ANH. All were given prophylaxis from birth. Six months to 16years (median 6years) follow-up was available for 54 (42 males, 12 females). All but two patients had grade III-V VUR (96%), bilaterally in 41 (76%). CRN was evident in 30 (56%; all male) and bladder dysfunction in 12 (22%; 10 males). Twenty-eight patients (52%) developed a UTI. The risk of UTI was 58% in girls, 33% in boys without CRN and 57% in boys with CRN (p = 0.17). Bladder dysfunction was a significant risk factor for UTI (p = 0.03). All 8 (15%; 7 males) with NRD had had a UTI. A single UTI appeared responsible for the majority of NRD (6/8; 75%). UTI occurred in 6/27 (22%) boys after circumcision compared to 17/25 (68%) prior/without circumcision (p < 0.05). CONCLUSIONS The incidence of UTI in VUR detected after presentation with ANH was 52%. CRN and bladder dysfunction were risk factors for developing a UTI. Circumcision appears to significantly reduce the risk of infection. Antenatal presentation of primary VUR does not carry a reduced risk of UTI. A single UTI, in half before the age of six months, seemed responsible for the majority of NRD. In boys, the highest risk of UTI is in the first few months of infancy, despite antibiotic prophylaxis, and other interventions, particularly circumcision, should therefore be considered as early as possible.
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Affiliation(s)
- Kathryn Evans
- Department of Paediatric Surgery, St George's Healthcare NHS Trust, London, UK; Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
| | - Maria Asimakadou
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
| | - Oluchi Nwankwo
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
| | - Divyesh Desai
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
| | - Abraham Cherian
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
| | - Imran Mushtaq
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
| | - Peter Cuckow
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
| | - Patrick Duffy
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
| | - Naima Smeulders
- Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
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Abstract
Background: A majority of cystic lesions in the western world are detected antenatally, whereas, the diagnosis in our setup occurs once the child becomes symptomatic. Surgical management is primarily dictated by the presence of symptoms, recurrent infection, and rarely by the potential risk of malignant transformation. Materials and Methods: A retrospective analysis was carried out on all consecutive patients with cystic lung lesions managed at our center from January 2000 through June 2011 for antenatal diagnosis, presentation, diagnostic modalities, treatment, and complications. Results: Forty cystic lung lesions were identified. Only 8% were antenatally detected. Out of 40, the final diagnosis was congenital cystic adenomatoid malformation in 19, congenital lobar emphysema in 11, and bronchogenic cysts and pulmonary sequestration in five each. Of these, 20% had received a course of prior antitubercular therapy and 30% had an intercostal drain inserted prior to referral to our center. Postoperative morbidity in the form of bronchopleural fistula, pneumothorax, and non-expansion of the residual lung was noted in 10% of the patients. Conclusion: Antenatal diagnosis of these lesions is still uncommon in third world countries. Prior to referral to a pediatric surgical center a large number of patients received antitubercular drugs and an intercostal drain insertion, due to incorrect diagnosis.
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Affiliation(s)
- V Shankar Raman
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Veereshwar Bhatnagar
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shasanka Shekhar Panda
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Charif D'Ouazzane M, Gueroui I, Betaich K, Bennani R, Touati Z, Haddour L, Cherti M. [A cardiac rhabdomyome evoking the antenatal diagnosis of a Bourneville's tuberous sclerosis]. Ann Cardiol Angeiol (Paris) 2015; 64:51-53. [PMID: 22621850 DOI: 10.1016/j.ancard.2012.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 04/15/2012] [Indexed: 06/01/2023]
Abstract
Rare hereditary affection, the Bourneville's tuberous sclerosis (BTS) is an autosomal dominant inherited phakomatosis. Rhabdomyomes are the most frequent cardiac tumors in children and infants, they are one of the most premature modes of revelation of the STB. They sometimes allow to envisage the diagnosis in antenatal period at the same time as the genetic and neurological explorations. We report the diagnosis of a fetal BTS evoked by the antenatal discovery of a cardiac rhabdomyome. The antenatal cerebral explorations, realized by magnetic resonance imagery (MRI), put evidence cerebral localisations confirming the diagnosis.
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Affiliation(s)
| | - I Gueroui
- Service de cardiologie B, CHU Ibn Sina, Rabat, Maroc
| | - K Betaich
- Service de cardiologie B, CHU Ibn Sina, Rabat, Maroc
| | - R Bennani
- Service de cardiologie B, CHU Ibn Sina, Rabat, Maroc
| | - Z Touati
- Service de cardiologie B, CHU Ibn Sina, Rabat, Maroc
| | - L Haddour
- Service de cardiologie B, CHU Ibn Sina, Rabat, Maroc
| | - M Cherti
- Service de cardiologie B, CHU Ibn Sina, Rabat, Maroc
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45
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Abstract
Antenatal hydronephrosis (ANH) is one of the most frequently detected abnormalities found on routine prenatal ultrasounds, affecting 1% to 4.5% of all pregnancies. Despite its prevalence, there continues to be uncertainty regarding the clinical impact after birth. Prognosis depends on the severity of the dilation. Expectant prenatal management is the rule with fetal intervention rarely needed in a few select cases. Ureteropelvic junction obstruction and vesicoureteral reflux are the most common postnatal diagnoses. A renal and bladder ultrasound is essential in the follow-up of patients with ANH and helps dictate further investigation with voiding cystourethrography and/or diuretic renography.
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Affiliation(s)
- Dennis B Liu
- Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Urology, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA.
| | - William R Armstrong
- Department of Urology, University of Illinois Chicago College of Medicine, 820 South Wood Street, M/C 955, Chicago, IL 60612, USA
| | - Max Maizels
- Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Urology, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA
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Sarhan OM, Alghanbar M, Alsulaihim A, Alharbi B, Alotay A, Nakshabandi Z. Multicystic dysplastic kidney: Impact of imaging modality selection on the initial management and prognosis. J Pediatr Urol 2014; 10:645-9. [PMID: 24731390 DOI: 10.1016/j.jpurol.2014.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/18/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the impact of imaging modalities on the evaluation and prognosis of children with multicystic dysplastic kidney (MCDK) disease. PATIENTS AND METHODS A retrospective analysis of all children with MCDK diagnosed from 2004 until 2012 was performed. The study included 63 patients for whom all postnatal imaging modalities were available: renal bladder ultrasound (RBUS), dimercaptosuccinic acid scan (DMSA) and voiding cystourethrogram (VCUG). Cases with major congenital abnormalities or incomplete data were excluded. Abnormalities in the contralateral kidney and the fate of MCDK were also addressed. RESULTS At diagnosis, the average age was four-and-a-half months. The majority of cases were detected antenatally (87%). Postnatal RBUS and DMSA scans established the diagnosis of MCDK in 92% and 98% of patients, respectively. DMSA showed photopenic areas in the contralateral kidneys in 10% of patients; all of them had hydronephrosis and were confirmed to have vesicoureteral reflux (VUR). Contralateral VUR was detected in 16 patients; 63% of them had hydronephrosis. After a mean follow-up of three-and-a-half years, involution occurred in 62% of patients and the involution rate was inversely proportional to the initial size. CONCLUSIONS The classical appearance of MCDK on RBUS was sufficient to establish the diagnosis in most patients. DMSA scan was more accurate in confirming the diagnosis and evaluating the contralateral kidney. Selective screening for VUR in patients with contralateral hydronephrotic kidney should be considered.
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Nishizawa C, Cajusay-Velasco S, Mashima M, Mori N, Hayashi K, Kubo H, Shimono R, Koyano K, Hata T. HDlive imaging of fetal enteric duplication cyst. J Med Ultrason (2001) 2014; 41:511-4. [PMID: 27278035 DOI: 10.1007/s10396-014-0548-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/24/2014] [Indexed: 12/28/2022]
Abstract
Enteric duplication cysts are rare congenital anomalies, but their antenatal diagnosis is becoming more common because of advances in ultrasonography. With the latest state-of-the-art technology, HDlive facilitates a more realistic anatomical visualization of different fetal organ structures, making diagnosis more precise. We present a case of antenatal HDlive imaging of an enteric duplication cyst. A 26-year-old pregnant Japanese woman was referred to our ultrasound clinic because of a fetal intra-abdominal cyst at 27 weeks of gestation. Two-dimensional (2D) ultrasound revealed a sonolucent, ellipsoid structure in the subhepatic area. Magnetic resonance imaging yielded the same findings. However, irregular internal echoes appeared at 33 weeks of gestation. There was no vascularity on color Doppler. HDlive clearly depicted a more realistic image of the circular mass, which was thick walled, with a large amount of debris inside, and showed no communication with adjacent structures. Careful monitoring was conducted for these unusual findings. A day after delivery, an emergency operation was performed because the infant had sudden signs and symptoms of obstruction. Intra-operative findings were ileus and a necrotic ileal duplication cyst confirmed by histopathologic studies. Complications of enteric duplication cyst can arise at any time of life, and so thorough monitoring may be recommended. The findings of irregular internal echoes and a large amount of debris inside the cyst are relatively characteristic features of a complicated cyst. HDlive gives us additional information on the actual appearance of a complicated cyst that may be difficult to obtain using conventional 2D sonography alone. HDlive can be very useful in the antenatal surveillance of enteric duplication cysts.
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Affiliation(s)
- Chika Nishizawa
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Sarah Cajusay-Velasco
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Masato Mashima
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Nobuhiro Mori
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Keiji Hayashi
- Department of Obstetrics and Gynecology, Uchinomi Hospital, 44-95 Katajo-Kou, Shoudoshima-cho, Shouzu-gun, Kagawa, 761-4431, Japan
| | - Hiroyuki Kubo
- Department of Pediatric Surgery, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Ryuichi Shimono
- Department of Pediatric Surgery, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kosuke Koyano
- Department of Pediatrics, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan.
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Udayakumar P, Arunachalam P, Vijayakumar V, Kandappan G. Ex-utero intrapartum treatment in the Indian scenario: Anesthetic challenges and positioning. J Indian Assoc Pediatr Surg 2014; 19:106-8. [PMID: 24741216 PMCID: PMC3983761 DOI: 10.4103/0971-9261.129608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ex-utero intrapartum treatment (EXIT) is performed for fetuses diagnosed with large neck masses. A case report of a fetus diagnosed with a large cystic hygroma and cord around the neck who was delivered by EXIT is presented. The airway challenges and optimal positioning is discussed.
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Affiliation(s)
- Prabha Udayakumar
- Department of Anaesthesiology, P.S. Govindaswamy Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Pavai Arunachalam
- Department of Paediatric Surgery, P.S. Govindaswamy Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Vinodhadevi Vijayakumar
- Department of Anaesthesiology, P.S. Govindaswamy Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Gunavathi Kandappan
- Department of Anaesthesiology, P.S. Govindaswamy Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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49
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Abstract
We describe the echocardiographic features of submitral aneurysm in a 26 week old fetus. The diagnosis was confirmed on neonatal echocardiography.
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Affiliation(s)
- Neeraj Awasthy
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
| | - Savitri Shrivastava
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
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Nadar R, Khatod K, Phadke N, Datar C, Vaidya S, Khadilkar A, Khadilkar V. Molecular characterization in a case of isolated growth hormone deficiency and further prenatal diagnosis of an unborn sibling. Indian J Hum Genet 2014; 19:475-8. [PMID: 24497717 PMCID: PMC3897147 DOI: 10.4103/0971-6866.124380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Familial isolated growth hormone deficiency (GHD) type 1 is characterized by an autosomal recessive pattern of inheritance with varying degrees of phenotypic severity. We report a proband, with isolated GHD (IGHD) with very early growth arrest and undetectable levels of GH. Homozygous complete deletion of the GH1 gene was identified by real-time/quantitative polymerase chain reaction (RT/q-PCR) and confirmed by an independent molecular genetic method; the multiplex ligation-dependent probe amplification (MLPA) technique. Prenatal diagnosis was offered for the subsequent pregnancy in the mother of our proband. Identical heterozygous deletion of the GH1 gene was detected in both parents. The fetus had a similar homozygous deletion of the GH1 gene. We thus report a unique case with a confirmed mutation in GH1 gene in the proband followed by prenatal detection of the same mutation in the amniotic fluid which to our knowledge hitherto has not been documented from India.
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Affiliation(s)
- Ruchi Nadar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Camp, Pune, Maharashtra, India
| | - Kavita Khatod
- GenePath Dx, Causeway Healthcare, Phadke Hospital, Shivaji Nagar, Pune, Maharashtra, India
| | - Nikhil Phadke
- GenePath Dx, Causeway Healthcare, Phadke Hospital, Shivaji Nagar, Pune, Maharashtra, India
| | - Chaitanya Datar
- Sahyadri Medical Genetics and Tissue Engineering Facility, Shivajinagar, Pune, Maharashtra, India
| | - Sujata Vaidya
- Sahyadri Medical Genetics and Tissue Engineering Facility, Shivajinagar, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Camp, Pune, Maharashtra, India ; GenePath Dx, Causeway Healthcare, Phadke Hospital, Shivaji Nagar, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Camp, Pune, Maharashtra, India
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