Diagnostic performance and role of the contrast enema for low intestinal obstruction in neonates

• Published in: Pediatric surgery international Vol. 36; no. 9; pp. 1093 - 1101
• Main Authors: Baad, Michael, Delgado, Jorge, Dayneka, Jillian S., Anupindi, Sudha A., Reid, Janet R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2020; Springer Nature B.V
• Subjects: Abdomen; Barium Enema - methods; Colon; Colon - abnormalities; Cystic fibrosis; Female; Gestational age; Hospitals; Humans; Infant, Newborn; Intestinal Atresia; Intestinal obstruction; Intestinal Obstruction - complications; Intestinal Obstruction - diagnosis; Intestine, Small - abnormalities; Male; Medical diagnosis; Medicine; Medicine & Public Health; Newborn babies; Original Article; Patients; Pediatric Surgery; Pediatrics; Reproducibility of Results; Retrospective Studies; Studies; Surgery; Contrast enema; Fluoroscopy; Neonatal obstruction; Hirschsprung disease
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-020-04701-4

Purpose We aim to evaluate the diagnostic performance and relationship between clinical characteristics, imaging findings, and final diagnosis for the neonatal contrast enema (CE). Methods Retrospective 10-year review of all neonatal CEs including imaging findings, clinical information, indication, and final diagnosis from discharge summaries, surgical reports, and pathology (reference standard). Two blinded pediatric radiologists reinterpreted 366 CEs for obstruction, microcolon, rectosigmoid index (RSI), serrations, meconium, ileal cut-off, transition zone, diagnosis, and level of confidence. CE diagnostic performance was calculated versus reference standard. Results Diagnoses included Hirschsprung disease (HD) (15.8%), small left colon syndrome (14.8%), small intestinal atresia/colonic atresia (SIA/CA) (12.6%), meconium ileus (MI) (4.4%), and normal (48.9%). CE had a moderate specificity (87.7%) and low sensitivity (65.5%) for HD; abnormal RSI and serrations showed high specificities (90.3%, 97.4%) but low sensitivities (46.6%, 17.2%). CE showed high specificity (97.4%) and low sensitivity (56.3%) for MI blinded to cystic fibrosis status. Microcolon was specific (96.6%) but not sensitive (68.8%) for MI. CE showed highest PPV (73.1%) (specificity 95.6%, sensitivity 82.6%) for SIA/CA. Microcolon with an abrupt cut-off was specific (99.1%) but not sensitive (41.3%) for atresias. Conclusion Neonatal CE demonstrates high specificities and low to moderate sensitivities across all diagnoses, with lowest performance in HD. Clinical trial registration None.