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

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Abstract

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.

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Abbreviations

CE:

Contrast enema

RSI:

Ectosigmoid index

Z:

Transition zone

HD:

Hirschsprung disease

SLCS:

Small left colon syndrome

SIA:

Small intestinal atresia

CA:

Colonic atresia

MI:

Meconium ileus

CF:

Cystic fibrosis

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Funding

The authors have no financial relationships relevant to this article to disclose. This project was completed without a specific funding source.

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Authors and Affiliations

  1. Department of Radiology, Weill Cornell Medicine, 525 E 68th Street, Starr 8A-37, New York, NY, 10065, USA

    Michael Baad

  2. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Jorge Delgado

  3. Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, 3NW13, Philadelphia, PA, 19104, USA

    Jillian S. Dayneka, Sudha A. Anupindi & Janet R. Reid

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  1. Michael Baad
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  5. Janet R. Reid
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Contributions

Dr. Reid conceptualized and designed the study, supervised data collection, and reviewed and revised the manuscript. Dr. Baad collected data, conducted the initial analysis, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Delgado conceptualized and designed the study, collected data, conducted statistical data analysis, and reviewed and revised the manuscript. Ms. Dayneka conducted data analysis and reviewed and revised the manuscript. Dr. Anupindi collected data and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Michael Baad.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of the Children’s Hospital of Philadelphia and is compliant with the 1964 Helsinki declaration and its later amendments. This retrospective study was approved by the institutional review board of the Children’s Hospital of Philadelphia and compliant with the Health Insurance Portability and Accountability Act.

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The requirement to obtain informed consent for this retrospective study was waived by our institutional review board.

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Baad, M., Delgado, J., Dayneka, J.S. et al. Diagnostic performance and role of the contrast enema for low intestinal obstruction in neonates. Pediatr Surg Int 36, 1093–1101 (2020). https://doi.org/10.1007/s00383-020-04701-4

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