Ultrasound assessment of abdominal adhesions in neonates: data over dogma for re-operative timing
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In brief
In brief
This prospective study demonstrates that surgeon-performed ultrasound can accurately identify the location and severity of post-operative abdominal adhesions in neonates. The findings suggest ultrasound assessment could enable earlier safe reoperation, potentially reducing TPN dependence, central line complications, and NICU length of stay.
Written by the GCMD Library team from the article.
Abstract
Introduction
Neonatal abdominal reoperation is difficult and can be complicated by abdominal adhesions. Identifying patients who could safely undergo early reoperation would save TPN and central line days, decrease associated infection and liver injury, and NICU and hospital length of stay. We sought to determine if ultrasound (US) could accurately assess the location and severity of adhesions in neonates as an objective dynamic marker capable of informing reoperation timing.
Methods
After IRB approval, we conducted a prospective observational study including neonates undergoing abdominal operations. Patients received surgeon-performed US approximately every 2 weeks until reoperation or discharge. Adhesions were assessed in five zones: right upper quadrant (RUQ), right lower quadrant (RLQ), left upper quadrant (LUQ), left lower quadrant (LLQ) and peri-incision (INC).
Results
Over a 6-month study period, 16 neonates were enrolled. Median gestational age was 34 weeks at birth and median weight 2.2 kg. 6 underwent reoperation within initial NICU admission. At time of operation US correctly identified the absence or presence and severity of adhesions in: RUQ (3/3); RLQ (6/6); LUQ (4/5); LLQ (6/6); and INC (5/5).
Conclusion
US can identify location and severity of post-operative adhesions in neonates, potentially identifying patients who can safely undergo reoperation earlier than predetermined wait periods.
Level of evidence
IV.