Anemia of Prematurity - Portal Neonatal

o With abdominal ultrasonography, a skilled physician can identify a larger amount of
diagnostic information faster and with less risk to the baby than with the current
o tandard evaluation methods.
o Abdominal air (easily observed on ultrasonography and in grossly distended patients)
can interfere with assessing intra-abdominal structures.
o Ultrasonography can be used to identify areas of loculation and/or abscess consistent
with a walled-off perforation when patients with indolent NEC have scarce gas or a
fixed area of radiographic density.
o Ultrasonography is excellent for distinguishing fluid from air, so ascites can be
identified and quantified. Serial examinations can be used to monitor the progression of
ascites as a marker for the disease course.
o Portal air can be easily observed as bubbles present in the venous system. This finding
has been termed informally the "champagne sign" because of its similar appearance to
a champagne flute.
o Recent data suggest that ultrasonographic assessment of major splanchnic
vasculature can help in the differential diagnosis of NEC from other more benign and
emergent disorders.
• The orientation of the superior mesenteric artery in relationship to the superior mesenteric vein
can provide information regarding the possibility of a malrotation with a subsequent volvulus. If
a volvulus is present, the artery and vein are twisted and, at some point in their courses, their
orientation switches. This abnormality can be detected, even if the rotation is 360 degrees, if
the full path of the vessels can be observed.
• Doppler study of the splanchnic arteries early in the course of NEC can help distinguish
developing NEC from benign feeding intolerance in a mildly symptomatic baby.
• A clinical study from Europe and a recent small series in the United States demonstrate
markedly increased peak flow velocity (>1.00) of arterial blood flow in the celiac and superior
mesenteric arteries in early NEC. Such a finding at the presentation of symptoms can further
aid in diagnosis and therapy, potentially sparing those individuals at low risk for NEC from
unnecessary interventions.
Procedures:
• Upper GI (with or without) small bowel follow-through
o This procedure is a definitive way to diagnose the presence or absence of intestinal
volvulus.
o Always consider intestinal volvulus if bilious vomiting is present, especially in the term
infant.
o Because the presence of volvulus is a surgical emergency, it is an important diagnosis
to exclude in a neonate with abdominal symptoms.
o Perform before contrast enema because the presence of contrast in the colon can
obscure pertinent findings.
• Contrast enema
o This procedure is a definitive way to diagnose a distal obstruction.
o Always use a water-soluble contrast agent because of the risk of perforation. Contrast
enemas are contraindicated in the presence of perforation. Consider carefully the
clinical risks and benefits before undertaking this evaluation in the unstable and/or
acutely ill infant.
o Contrast enema findings are important for the differential diagnosis of intestinal
abnormalities because distal obstructions, such as meconium plug, small left colon
syndrome, and Hirschsprung disease, may cause symptoms in the baby without
fulminant systemic collapse.