Neonatal gastrointestinal obstruction : 17 years of single-institution experience

Neonatal gastrointestinal obstruction : 17 years of single-institution experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Neonatal gastrointestinal obstruction : 17 years of single-institution experience Lung-Huang Lin, Yi-Yang Chiu, Yuan-Ci Chen, Su-Ching Hu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6179755/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Gastrointestinal obstruction in newborns is a life-threatening condition caused by anatomical abnormalities that lead to failure to defecate. This is the most common surgical emergency for newborns. Prompt diagnosis, intervention, and implementation of appropriate management methods are important to improve outcomes in neonates with intestinal obstruction. This study aimed to explore the clinical characteristics and causes of gastrointestinal obstruction in a tertiary neonatal intensive care unit in Taiwan. Neonatal clinical and demographic characteristics, final diagnosis, surgical complications, and mortality were recorded. Methods This was a retrospective study conducted in a tertiary care medical center from May 2007 to November 2024. A total of 101 neonatal patients younger than 28 days of age who presented with gastrointestinal obstruction and underwent surgical intervention were enrolled. Results A total of 101 newborns were included in this study, with a male-to-female ratio of 1.8:1 and an average age of 4.4 days. The gestational age ranged from 24 to 40 weeks, with an average of 32.3 weeks, including 58 (57.4%) full-term infants and 43 (42.6%) premature infants. Birth weight ranged from 633 to 3675 g (average = 2425 g). Initial clinical manifestations included abdominal distension, bilious vomiting, and decreased activity levels. The mean age at presentation was 5 days, and the most common cause of intestinal obstruction was Hirschsprung disease (HD), which was observed in 23 (22.7%) cases. Other causes included 16 cases (15.8%) of malrotation, 11 cases (10.9%) of congenital diaphragmatic hernia (CDH), 11 cases (10.9%) of duodenal obstruction, 9 cases (8.9%) of meconium ileus, 8 cases (8%) of Meckel diverticulum, 6 cases (5.9%) of anorectal malformation (ARM), 6 cases (5.9%) of esophageal atresia, 3 cases (2.9%) of inguinal hernia, 2 cases (1.9%) of idiopathic hypertrophic pyloric stenosis (IHPS), 1 case (0.9%) of jejunal atresia, 1 case (0.9%) of duplication cyst, and 4 other cases (3.9%). After surgical correction, five patients died due to necrotizing enterocolitis, ileal perforation,and sepsis. Conclusion Morbidity and mortality from neonatal gastrointestinal obstruction have improved in recent years. In this study, we found that prenatal diagnosis, early referral, improved surgical techniques, and adequate staffing and postoperative care are critical for good outcomes. Hirschsprung disease (HD) Malrotation gut Anorectal malformation (ARM) Gastrointestinal obstruction Congenital diaphragmatic hernia (CDH) Idiopathic hypertrophic pyloric stenosis (IHPS) Neonate Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Congenital intestinal obstruction occurs hours or days after birth. In general, the further the intestinal obstruction is, the longer it will take for abdominal distension and vomiting to occur. Therefore, gastric pyloric obstruction can cause abdominal distension or vomiting within hours of birth, whereas symptoms of duodenal stenosis or obstruction may not appear until several days later. Symptoms of focal obstructions, such as small intestinal stenosis, may take years to develop [ 1 ]. Vomiting is a nonspecific symptom of neonatal illness. Symptoms will appear within a few days of birth, and vomit will be stained with bile. Intestinal atresia is a surgical emergency that requires immediate consultation with a surgeon. Vomiting can also be caused by infections, such as general respiratory viral infections, central nervous system infections, etc., and those in the gastrointestinal tract itself, such as viral or bacterial gastroenteritis. Metabolic diseases and endocrine abnormalities less commonly cause vomiting [ 1 ]. Physicians should be able to realize life-threatening causes of vomiting to avoid serious complications. If parents feel that their child's condition is not good, they should seek medical treatment for them as soon as possible to obtain a correct diagnosis to reduce the occurrence of accidents [ 2 ]. Presumptive diagnosis of intestinal obstruction is based on the presence of abdominal distension, bilious vomiting, the absence of meconium passage within the first day of life, and polyhydramnios during pregnancy. Newborns with intestinal obstruction may develop complications such as the aspiration of vomitus, sepsis, midgut infarction, or enterocolitis [ 3 ]. A plain abdominal X-ray is rarely sufficient to diagnose the condition but should be the first step. Surgery is usually required to resolve neonatal intestinal obstruction. Early diagnosis and treatment can improve outcomes. In this study, we enrolled 101 neonatal patients < 28 days of age with gastrointestinal obstruction who underwent surgical intervention. The main causes of neonatal gastrointestinal obstruction include HD, malrotation, CDH, duodenal obstruction, meconium ileus, Meckel diverticulum, ARM, esophageal atresia, pyloric stenosis, jejunal stenosis, duplication cyst, etc. Initial clinical manifestations include abdominal distension and bilious vomiting. Risk factors for poor surgical outcomes consist of prematurity, low birth weight, late presentation, and associated congenital anomalies. After surgical correction, five patients died due to necrotizing enterocolitis, ileal perforation, and sepsis. Materials and Methods This was a retrospective study conducted at a tertiary care center in Taiwan from May 2007 to November 2024. A total of 101 neonatal patients younger than 28 days old were enrolled in this study. All of these cases presented with intestinal obstruction and underwent surgical intervention. Inclusion criteria included all neonates who had gastrointestinal obstruction during the study period with complete records. Exclusion criteria included neonatal gastrointestinal obstruction cases with incomplete records. Results Among the 101 patients included, 65 were male and 36 were female. The male-to-female ratio was 1.8:1. Gestational age ranged from 24 to 40 weeks (mean = 32.3 weeks), and birth weight ranged from 0.64 to 3.6 kg (mean = 2.42 kg). The most common cause of intestinal obstruction was Hirschsprung disease, followed by malrotation, CDH, duodenal obstruction, meconium ileus, Meckel diverticulum, ARM, esophageal atresia, inguinal hernia, IHPS, jejunal atresia, and duplication cyst (Table 1 ). Most newborns develop symptoms within the first week of life, but HD, Meckel diverticulum, inguinal hernia, IHPS, and duplication cyst presented later (i.e., after the 2nd week). The mean time to symptom onset in our patients was 3.85 days, which is consistent with most previous studies (Table 2 ). A male newborn was admitted to the neonatal intensive care unit due to severe abdominal distension and polyhydramnios during a prenatal ultrasound examination. Lower gastrointestinal imaging showed an abrupt transition zone at the rectosigmoid junction and the dilatation of the remainder of the colon. The lateral view of an enema shows that the diameter of the rectum is narrower than that of the sigmoid colon. The rectosigmoid ratio is < 1; therefore, rectosigmoid inversion is present and compatible with HD (Fig. 1a and b ). Abnormal relative positions of the SMA and SMV can lead to intestinal malrotation, thereby inducing midgut volvulus. We present a rare case of neonatal midgut malrotation and volvulus in a 5-day-old female newborn who presented with abdominal distension and bilious vomiting. Abdominal color Doppler ultrasonography revealed an inverted position of the SMA and SMV, with the SMV located anterior and to the left of the SMA (Fig. 2a and b ). The transverse ultrasonography of the upper abdomen revealed a “whirlpool sign,” a finding consistent with midgut volvulus. Upper gastrointestinal tract imaging showed the dislocation of the duodenojejunal flexure and a corkscrew sign in the duodenum, which showed that the twisting of the midgut formed a spiral curve, thus resembling an "apple peel/twisted ribbon" (Fig. 3a and b ). CDH is characterized by the incomplete closure of the diaphragm and the subsequent compression of the fetal lungs, resulting in underdeveloped lungs. We present a case of a term infant who developed respiratory distress after birth. Radiographic examination confirmed a larger CDH on the left side. A chest X-ray taken immediately after the repair of CDH showed a clean contour of the diaphragm and the normal lung parenchyma (Fig. 4a and b ). Duodenal webs refer to the complete or incomplete obstruction of the duodenum due to the presence of membrane webs or intraluminal diverticula. This abnormality is one of the leading causes of intestinal obstruction in newborns. We report a case of a neonate who developed bilious vomiting two days after birth and failed to pass meconium after birth. Abdominal X-ray examination showed that the stomach and duodenal bulb were filled with gas and expanded, thus causing the "double bubble sign". The patient’s characteristics were consistent with the duodenal network. The stomach and the first and second parts of the duodenum were dilated, giving it a windsock appearance. The patient's characteristics were also consistent with the duodenal web (Fig. 5a and b ). An incarcerated inguinal hernia can lead to bowel obstruction, strangulation, and infarction. Irreducibility is an ever-present risk with untreated inguinal hernia, and its management remains a key component of pediatric surgical practice. When hernias are irreducible, morbidity and mortality are increased. A 26-day-old newborn was admitted to the hospital due to irreducible inguinal hernia. He presented with irritability, loss of appetite, vomiting, abnormal defecation, left groin tenderness, and scrotal swelling. There were fluid-filled, dilated loops of the small intestine in an incarcerated inguinal hernia that was revealed using scrotal ultrasound. Abdominal ultrasound imaging showed fluid-filled, dilated small bowel loops secondary to incarcerated inguinal hernia (Fig. 6a and b ). The patients in all the above cases were discharged successfully after surgery. Discussion Our study shows that HD was the most common cause of neonatal intestinal obstruction leading to surgery at our center. The incidence of HD is approximately 1 in 2,000 to 5,000 live births, and the male-to-female ratio is approximately 4 to 1. HD may be genetic. The most common site of this disease is the sigmoid colon, accounting for 75% of cases; only the rectum is affected in about 20%; the entire large intestine is affected in about 2%. The most unfortunate case is when the whole intestine is deficient in ganglion cells (total aganglionosis), accounting for about one percent of cases [ 4 ]. HD is one of the common congenital diseases treated in pediatric surgery. Careful observation and treatment by a responsible physician are required, as in some unfortunate cases, babies develop colitis or intestinal rupture soon after birth. The occurrence of sepsis can lead to death, so urgent and appropriate treatment can reduce its mortality, as can increased alertness to the possibility of diagnosing this disease, appropriate preoperative treatment and surgery, and successful postoperative care. Rates and complications: If a newborn does not defecate within 48 hours after birth, the possibility of suffering from congenital intestinal obstruction is greatly increased. Mechanical bowel obstruction (e.g., esophageal atresia or intestinal atresia) and functional bowel obstruction (e.g., HD) should be considered. Newborns with intestinal obstruction generally experience abdominal distension and vomiting; unsatisfactory weight gain, or even weight loss; and a significant reduction in activity. The incidence rate of preoperative intestinal perforation in HD neonates is 6.0%, which mainly occurs in short-segment and long-segment HD. Perforations are mainly located in the normally innervated upstream segments. Prompt surgical intervention, especially ostomy, results in good outcomes for most patients [ 4 , 5 ]. In this study, the second cause of bowel obstruction leading to neonatal surgery was intestinal malrotation. Congenital volvulus is mainly caused by the sequential rotation of the duodenum and large intestine along the superior mesenteric artery in the abdominal cavity to achieve normal positioning during the embryonic period; however, if abnormalities occur during the rotation, malrotation may occur. This may cause the intestines to continuously twist, leading to the partial or complete obstruction of the gastrointestinal tract. Once the intestines are twisted tightly, blood circulation will stop, and intestinal necrosis will occur, leading to peritonitis or even sepsis, which is life-threatening. During the disease process, if detected early, the intestines can be loosened through surgery; if the intestines are already necrotic, the necrotic parts can be removed; however, if too much is removed, short bowel syndrome will occur, resulting in the inability to absorb food in the future. Inadequate nutrition may lead to related complications. If volvulus is confirmed, the sooner surgery is performed, the less likely complications will arise; prognosis will vary based on the site and length of resection. Ultrasound offers advantages such as accessibility, portability, the absence of ionizing radiation, and the ability to identify alternative diagnoses, and it is beginning to attract widespread attention and consideration in the literature [ 6 , 7 ]. Ultrasonography has the advantage of enabling flexible multi-section dynamic assessment and is a valuable tool for diagnosing and determining the cause of intestinal obstruction in neonates. The accuracy of ultrasound in diagnosing intestinal obstruction is 91%, and that in diagnosing the cause of intestinal obstruction is 84% [ 8 ].Laparoscopic correction of midgut malrotation does not increase the risk of postoperative volvulus and reduces the incidence of adhesive small bowel obstruction [ 9 ]. The mean time to symptom onset in our patients was 3.85 days, which is consistent with most previous studies. Our results showed that the third cause of bowel obstruction leading to neonatal surgery is CDH. This is a rare congenital disease (according to statistics, the incidence rate is about 1/2000 to 1/5000) caused by the underdevelopment of the diaphragm during the embryonic period (about 7 to 10 weeks of pregnancy), which causes the abdominal organs to slide into the chest cavity, thus leading to pulmonary hypoplasia and altered pulmonary vascular development. The abnormal development of lung tissue and blood vessels leads to poor ventilation and persistent pulmonary hypertension. Common symptoms include dyspnea, shortness of breath, hypoxia, cyanosis, and chest asymmetry on both sides. In addition, due to abdominal organs (such as intestines, stomach, and liver) sliding into the chest or abdomen, the abdomen may be sunken, or even intestinal obstruction, torsion, and necrosis may occur. The diagnosis of CDH is the most important predictor of sepsis and death on arrival, so steps should be taken for early recognition and aggressive treatment [ 10 ]. Small bowel obstruction is a common complication after CDH repair, resulting in significant morbidity and potential mortality. There were no cases of such complications in our study [ 11 ]. Our study found that the fourth cause of bowel obstruction leading to neonatal surgery is duodenal atresia or stenosis. Patients with duodenal atresia may develop high intestinal obstruction within hours of birth, with vomiting as the main symptom. More than 90% of patients have bile in their vomitus. Due to the high location of the obstruction, there will be no obvious abdominal distension, but dehydration, electrolyte imbalance, and metabolic alkalosis will soon occur. Symptoms in patients with duodenal stenosis appear slowly, and vomiting symptoms tend to become more pronounced with increased feeding. Patients with small intestinal atresia may also experience bile-containing vomiting clinically, but the abdominal distension is much more severe than that in patients with duodenal atresia. In general, the more severe the bloating, the lower the obstruction is. Consistent with other reports, duodenal atresia is the most common type of intestinal atresia, followed by ileal atresia [ 12 ]. After excluding midgut volvulus, segmental volvulus should be considered one of the differential diagnoses in all infants with bilious vomiting, especially in the presence of fetal ultrasound abnormalities and abdominal distension [ 13 ]. In addition, patients with congenital intestinal obstruction often have no meconium or only a small amount of meconium after birth. Preoperative treatment includes using an indwelling gastric tube for gastric decompression to avoid aspiration pneumonia caused by vomiting and reduce abdominal distension, thus quickly correcting dehydration and electrolyte and metabolic imbalances. In this case, broad-spectrum antibiotics are administered intravenously. In principle, end-to-end anastomosis of the intestine is generally performed to restore the smooth flow of the intestine. For small bowel atresia, the resection of part of the hypertrophic proximal end is often necessary to avoid postoperative functional obstruction. It is also necessary to ensure the patency of the distal intestine during surgery, and the possibility of multiple small intestinal atresia cannot be ignored. Duodenal stenosis caused by annular pancreas is usually treated with side-to-side duodenal anastomosis, but if this is difficult, duodenojejunal anastomosis can also be performed. For stenosis caused by the diaphragm in the intestine, the intestine can be incised, the diaphragm cut off, and the intestinal incision sutured. It is not necessary to remove the narrowed portion of the intestine [ 14 – 16 ]. In recent years, minimally invasive surgery has been proven to be feasible and safe for the treatment of duodenal obstruction, with results comparable to traditional open surgery. Its effectiveness can be significantly improved with proper training [ 17 ]. Meconium ileus occurs in 12–20% of newborns diagnosed with cystic fibrosis and is often the first manifestation of the disease; it is defined as perinatal mechanical small bowel obstruction caused by concentrated meconium in the terminal ileum. Newborns with cystic fibrosis and meconium intestinal obstruction are treated very differently and according to different national standards [ 18 ]. If a newborn has intestinal obstruction and does not pass meconium within 48 hours after birth, meconium intestinal obstruction should be highly suspected. To date, only seven cystic fibrosis patients (from six different families) have been reported in Taiwan [ 19 , 20 ]. The incidence of ARM is about 1/4000 newborns, including abnormalities of varying degrees from simple low-level abnormalities to complex cloacal malformations. Children with ARM suffer from a variety of medical conditions. Early complications after corrective surgery are common. Intensive care for complex and elective corrective procedures for ARM remains a critical quality-of-care issue given the large number of hospitals and extremely low caseloads [ 21 ]. Clinically, ARM is classified into the low type and high type. Twenty-four hours after birth, a careful observation of the perineum is the most important. Common combined abnormalities include congenital heart disease, urinary tract abnormalities, spinal abnormalities, etc. High-position abnormalities require a colostomy first, and the ideal stoma is in the descending colon. Posterior sagittal anorectoplasty is currently the most popular surgical method due to its direct observation and repair of abnormalities and fewer postoperative complications. The presence of bilious vomiting and contrast abnormalities in the neonate may represent malrotation; nevertheless, adrenal hemorrhage is a rare but important differential diagnosis [ 22 ]. Ultrasound remains an important screening tool for the evaluation of intestinal obstruction in newborns. The main ultrasound findings of intestinal obstruction include the differential dilatation of bowel loops, intestinal wall thickening, free fluid, and vascular abnormalities [ 23 , 24 ]. Laparoscopically assisted surgery is a safe and effective alternative to traditional open surgery for the treatment of pediatric incarcerated inguinal hernia. Its advantages include less trauma, faster recovery, shorter hospital stay, and fewer complications [ 25 ]. Prompt diagnosis, intervention, and implementation of appropriate management methods are important to improve the prognosis of neonates with intestinal obstruction. The timing of surgical intervention is a major predictor of complications of intestinal obstruction in neonates, and the prompt diagnosis and prompt treatment of these infants can significantly improve outcomes. Initial presentation and postoperative complications significantly influence the morbidity and mortality associated with the neonatal treatment of intestinal obstruction [ 26 ]. Congenital or acquired intestinal obstruction syndrome is the most common and severe causes of vomiting in newborns and the need for emergency treatment. Key extraintestinal causes of vomiting include brain tumors, meningitis, and inborn errors of metabolism. It is important to recognize red flags for urgent evaluation of vomiting, including nocturnal vomiting that awakens the patient, weight loss, hematemesis (especially during the first episode of vomiting), recurrent bilious vomiting, abdominal distension, absence of tympanic bowel sounds, and changes in mental status[ 1 ]. Intestinal obstruction is a common surgical emergency in neonates that often requires early diagnosis and appropriate treatment. However, when treatment or surgery is delayed, it can sometimes result in patients going into shock, which can even be life-threatening. Symptoms of intestinal obstruction in newborns may include the following: vomiting (with or without bile-staining material), abdominal distension, loss of appetite, and decreased mobility. These infants often suffer from electrolyte imbalances, acidosis, and fluid shock, which require aggressive treatment [ 27 ]. Conclusions Infants with unexplained gastrointestinal symptoms must be investigated for the possibility of congenital anomalies of the gastrointestinal tract. Conventional radiology remains very useful in diagnosing abnormalities of the gastrointestinal tract [ 28 ]. The treatment of intestinal obstruction in newborns requires collaboration between neonatologists and pediatric surgeons to determine the correct diagnosis and proceed with appropriate treatment [ 29 ]. With early intervention, cases of intestinal obstruction have lower morbidity and mortality. Outcomes depend in part on congenital comorbidities and delays in diagnosis and treatment. Declarations Data availability No datasets were generated or analysed during the current study. Acknowledgments We thank Mr. Bing-Han Yang for his unremitting efforts. Funding This research received no external funding. Author information Authors and Affiliations Chief of Pediatrics, Department of Pediatrics, Cathay General Hospital,Taipei, Taiwan Lung-Huang Lin Resident doctor, Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan Yi-Yang Chiu Attending Physician, Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan Yuan-Ci Chen , Su-Ching Hu Contributions L.H. L., Y.Y. C. and Y.C.C. made study conception and design. L.H. L., Y.Y. C., Y.C.C. and S.C.H. acquired data. L.H. L. and S.C.H. analyzed and interpreted data. L.H. L. drafted the manuscript. L.H. L. and S.C.H. revised critically. L.H. L. submitted the manuscript. All authors reviewed the manuscript. Corresponding author Correspondence to Lung-Huang Linor Su-Ching Hu. Conflict of interest The authors declare no competing interests. Ethical approval Approval for this study was obtained from the institutional review board (IRB) of the Cathay General Hospital, Taipei, Taiwan. (Approval No. CGH-P113079). This study adhered to the principles of good clinical practice and the Declaration of Helsinki, ensuring full compliance with patient data protection and privacy standards. References Silva Santos Í, Pinto F, Rocha G, Pissarra S (2023) Vomiting in neonates. J Pediatr Neonat Individual Med,12(2),e120201. Verma A, Rattan KN, Yadav R (2016) Neonatal intestinal obstruction: a 15 year experience in a tertiary care hospital. J Clin Diagn Res, 10(2), SC10-13. Singh S, Srivastav S, Agarwal N, Nagpure A, Khan TR (2024) Neonatal intestinal obstruction: etiology, management, and outcomes in a tertiary care center. Cureus, 16(6), e62971. Penaloza CSQ, Barreto AC, Ortolan EVP, Zani A, Lourenção PLTA (2024) Management of Hirschsprung's disease: a survey with Brazilian pediatric surgeons. Children (Basel),11(11),1405. 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Treider M, Granheim S, Engebretsen AH, Pripp AH, Røkkum H, Skari H, Sæter T, Bjørnland K (2023) Congenital duodenal obstruction: national trends in management and outcomes during the last quarter of a century in Norway. Eur J Pediatr Surg, 33(6),503-509. Tables Table 1 is available in the Supplementary Files section. Table 2. The age at which symptoms of various diseases appear. Disease <7 days 7-13 days 14-20 days 21-28 days Hirschsprung disease 18 0 4 1 Malrotation 15 1 0 0 Congenital diaphragmatic hernia 11 0 0 0 Duodenal obstruction 9 2 0 0 Meconium ileus 9 0 0 0 Meckel diverticulum 6 0 1 1 Anorectal malformation 6 0 0 0 Esophageal atresia 6 0 0 0 Inguinal hernia 1 0 1 1 Pyloric stenosis 0 1 1 0 Jejunal stenosis 1 0 0 0 Duplication cyst 0 0 1 0 Other 3 1 0 0 Total 85 5 8 3 Percentage 84.15 % 4.9 % 7.9 % 2.9 % Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6179755","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":429460254,"identity":"289e012d-f579-44d6-a014-f829a894b284","order_by":0,"name":"Lung-Huang Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYFACHoYDCT9s5PgZGNiI1sL44GFPmrFkA0wLYZ08zIYP2A4nbjhArBb+/rXHJBJ40hI3Hz9+7QFDxT27BvkeA7xaJG68S5NIsLAx3nYmp9yA4UxxcgMbD34tBhJnzEC2yG67wZMmwdiWkMzAxruBCC1shxk3zyBaC3+PsQFQi+IGCfZjIC12BLVI3OAxfJAIDGSJMzlsEglnEhLY2PI/4NXC33/G4OAPUFS2H38m8aEiwZ6f+VgCXi0MEnB5YEAB2Ylt+NWDrDkAY7E/AJH2BHWMglEwCkbBiAMAqYNGCN/z6egAAAAASUVORK5CYII=","orcid":"","institution":"Cathay General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Lung-Huang","middleName":"","lastName":"Lin","suffix":""},{"id":429460255,"identity":"dc6400ed-1e65-4381-b2f1-150a1a7ef65c","order_by":1,"name":"Yi-Yang Chiu","email":"","orcid":"","institution":"Cathay General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yi-Yang","middleName":"","lastName":"Chiu","suffix":""},{"id":429460256,"identity":"dcefb73e-e589-470f-a6c2-982feb6453a8","order_by":2,"name":"Yuan-Ci Chen","email":"","orcid":"","institution":"Cathay General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuan-Ci","middleName":"","lastName":"Chen","suffix":""},{"id":429460257,"identity":"30490df9-7466-437a-8675-72a92bc4a6b6","order_by":3,"name":"Su-Ching Hu","email":"","orcid":"","institution":"Cathay General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Su-Ching","middleName":"","lastName":"Hu","suffix":""}],"badges":[],"createdAt":"2025-03-07 16:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6179755/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6179755/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78920355,"identity":"68f3c865-588c-4c94-98e2-62d36888c118","added_by":"auto","created_at":"2025-03-20 20:26:46","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38510,"visible":true,"origin":"","legend":"\u003cp\u003ea. Lower gastrointestinal tract imaging shows that an abrupt transition zone is seen at the rectosigmoid junction with the dilatation of the remainder of the colon.\u003c/p\u003e\n\u003cp\u003eb. The lateral view of an enema shows that the diameter of the rectum is narrower than that of the sigmoid colon. The rectosigmoid ratio is \u0026lt;1; thus, there is recto-sigmoid inversion.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6179755/v1/a856b8e3c6173962a89e135b.jpg"},{"id":78920356,"identity":"32ae19ba-cb48-4cc0-9972-e7c1a3dec4b5","added_by":"auto","created_at":"2025-03-20 20:26:46","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":58266,"visible":true,"origin":"","legend":"\u003cp\u003ea and b. Color Doppler abdominal ultrasonography showed an inverted position of the superior mesenteric vessels, with the SMA located to the right of the SMV.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6179755/v1/8e8569eff7c5d1f8373675a8.jpg"},{"id":78920891,"identity":"c0558681-ab22-4bb0-86f4-aff25e8c7248","added_by":"auto","created_at":"2025-03-20 20:50:46","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":42585,"visible":true,"origin":"","legend":"\u003cp\u003ea. Contrast shows the dislocation of the duodenojejunal flexure and a corkscrew appearance of the jejunum. This confirmed malrotation and volvulus.\u003c/p\u003e\n\u003cp\u003eb. A transverse ultrasound of the upper abdomen revealed a \"whirlpool sign,\" a finding consistent with midgut volvulus.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6179755/v1/6b0d1c336e4a3feaad0cb2fe.jpg"},{"id":78920363,"identity":"6330b1cc-0ef0-48aa-8b45-2a7dcf894b28","added_by":"auto","created_at":"2025-03-20 20:26:46","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":52108,"visible":true,"origin":"","legend":"\u003cp\u003ea. A chest X-ray of a newborn showing large left diaphragmatic hernia.\u003c/p\u003e\n\u003cp\u003eb. A chest X-ray performed immediately after the repair of a congenital diaphragmatic hernia showed a clean contour of the diaphragm and the normal lung parenchyma.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6179755/v1/3d72f35ec8e3225de2c77e4c.jpg"},{"id":78920368,"identity":"77c624aa-2c98-4ffa-9cd1-17e478a194f9","added_by":"auto","created_at":"2025-03-20 20:26:46","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":47116,"visible":true,"origin":"","legend":"\u003cp\u003ea. An abdominal X-ray showed that the stomach (S) and duodenal bulb (D) were filled with gas and expanded, resulting in the \"double bubble sign\".\u003c/p\u003e\n\u003cp\u003eb. The stomach and the first and second parts of the duodenum are dilated, giving it a windsock appearance. The characteristics are consistent with a duodenal web.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6179755/v1/3235c98859aae6ef9ca30e8d.jpg"},{"id":78920782,"identity":"9783cf4c-2c3f-4c14-b379-c51cfe7f925d","added_by":"auto","created_at":"2025-03-20 20:42:46","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":54528,"visible":true,"origin":"","legend":"\u003cp\u003ea. Scrotal ultrasound in newborn shows left incarcerated inguinal hernia.\u003c/p\u003e\n\u003cp\u003eb. Abdominal ultrasound image demonstrates fluid-filled, dilated small bowel loops secondary to incarcerated inguinal hernia.\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6179755/v1/c781b17393426aba1b176534.jpg"},{"id":79038310,"identity":"cc2d4805-f9d1-4372-a591-be1e5ec28ef3","added_by":"auto","created_at":"2025-03-23 09:46:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":901292,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6179755/v1/10b4b9b1-315d-411d-921e-2cb3d64dc481.pdf"},{"id":78920361,"identity":"ad348330-e951-470e-a3eb-83a0bf54d93b","added_by":"auto","created_at":"2025-03-20 20:26:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18103,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6179755/v1/f7bd17973b7f0945f57854ed.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Neonatal gastrointestinal obstruction : 17 years of single-institution experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCongenital intestinal obstruction occurs hours or days after birth. In general, the further the intestinal obstruction is, the longer it will take for abdominal distension and vomiting to occur. Therefore, gastric pyloric obstruction can cause abdominal distension or vomiting within hours of birth, whereas symptoms of duodenal stenosis or obstruction may not appear until several days later. Symptoms of focal obstructions, such as small intestinal stenosis, may take years to develop [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVomiting is a nonspecific symptom of neonatal illness. Symptoms will appear within a few days of birth, and vomit will be stained with bile. Intestinal atresia is a surgical emergency that requires immediate consultation with a surgeon. Vomiting can also be caused by infections, such as general respiratory viral infections, central nervous system infections, etc., and those in the gastrointestinal tract itself, such as viral or bacterial gastroenteritis. Metabolic diseases and endocrine abnormalities less commonly cause vomiting [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Physicians should be able to realize life-threatening causes of vomiting to avoid serious complications.\u003c/p\u003e \u003cp\u003eIf parents feel that their child's condition is not good, they should seek medical treatment for them as soon as possible to obtain a correct diagnosis to reduce the occurrence of accidents [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Presumptive diagnosis of intestinal obstruction is based on the presence of abdominal distension, bilious vomiting, the absence of meconium passage within the first day of life, and polyhydramnios during pregnancy. Newborns with intestinal obstruction may develop complications such as the aspiration of vomitus, sepsis, midgut infarction, or enterocolitis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A plain abdominal X-ray is rarely sufficient to diagnose the condition but should be the first step. Surgery is usually required to resolve neonatal intestinal obstruction. Early diagnosis and treatment can improve outcomes.\u003c/p\u003e \u003cp\u003eIn this study, we enrolled 101 neonatal patients\u0026thinsp;\u0026lt;\u0026thinsp;28 days of age with gastrointestinal obstruction who underwent surgical intervention. The main causes of neonatal gastrointestinal obstruction include HD, malrotation, CDH, duodenal obstruction, meconium ileus, Meckel diverticulum, ARM, esophageal atresia, pyloric stenosis, jejunal stenosis, duplication cyst, etc. Initial clinical manifestations include abdominal distension and bilious vomiting. Risk factors for poor surgical outcomes consist of prematurity, low birth weight, late presentation, and associated congenital anomalies. After surgical correction, five patients died due to necrotizing enterocolitis, ileal perforation, and sepsis.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis was a retrospective study conducted at a tertiary care center in Taiwan from May 2007 to November 2024. A total of 101 neonatal patients younger than 28 days old were enrolled in this study. All of these cases presented with intestinal obstruction and underwent surgical intervention. Inclusion criteria included all neonates who had gastrointestinal obstruction during the study period with complete records. Exclusion criteria included neonatal gastrointestinal obstruction cases with incomplete records.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 101 patients included, 65 were male and 36 were female. The male-to-female ratio was 1.8:1. Gestational age ranged from 24 to 40 weeks (mean\u0026thinsp;=\u0026thinsp;32.3 weeks), and birth weight ranged from 0.64 to 3.6 kg (mean\u0026thinsp;=\u0026thinsp;2.42 kg). The most common cause of intestinal obstruction was Hirschsprung disease, followed by malrotation, CDH, duodenal obstruction, meconium ileus, Meckel diverticulum, ARM, esophageal atresia, inguinal hernia, IHPS, jejunal atresia, and duplication cyst (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Most newborns develop symptoms within the first week of life, but HD, Meckel diverticulum, inguinal hernia, IHPS, and duplication cyst presented later (i.e., after the 2nd week). The mean time to symptom onset in our patients was 3.85 days, which is consistent with most previous studies (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA male newborn was admitted to the neonatal intensive care unit due to severe abdominal distension and polyhydramnios during a prenatal ultrasound examination. Lower gastrointestinal imaging showed an abrupt transition zone at the rectosigmoid junction and the dilatation of the remainder of the colon. The lateral view of an enema shows that the diameter of the rectum is narrower than that of the sigmoid colon. The rectosigmoid ratio is \u0026lt;\u0026thinsp;1; therefore, rectosigmoid inversion is present and compatible with HD (Fig. 1a \u003cstrong\u003eand b\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eAbnormal relative positions of the SMA and SMV can lead to intestinal malrotation, thereby inducing midgut volvulus. We present a rare case of neonatal midgut malrotation and volvulus in a 5-day-old female newborn who presented with abdominal distension and bilious vomiting. Abdominal color Doppler ultrasonography revealed an inverted position of the SMA and SMV, with the SMV located anterior and to the left of the SMA (Fig. 2a \u003cstrong\u003eand b\u003c/strong\u003e). The transverse ultrasonography of the upper abdomen revealed a \u0026ldquo;whirlpool sign,\u0026rdquo; a finding consistent with midgut volvulus. Upper gastrointestinal tract imaging showed the dislocation of the duodenojejunal flexure and a corkscrew sign in the duodenum, which showed that the twisting of the midgut formed a spiral curve, thus resembling an \u0026quot;apple peel/twisted ribbon\u0026quot; (Fig. 3a \u003cstrong\u003eand b\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eCDH is characterized by the incomplete closure of the diaphragm and the subsequent compression of the fetal lungs, resulting in underdeveloped lungs. We present a case of a term infant who developed respiratory distress after birth. Radiographic examination confirmed a larger CDH on the left side. A chest X-ray taken immediately after the repair of CDH showed a clean contour of the diaphragm and the normal lung parenchyma (Fig. 4a \u003cstrong\u003eand b\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eDuodenal webs refer to the complete or incomplete obstruction of the duodenum due to the presence of membrane webs or intraluminal diverticula. This abnormality is one of the leading causes of intestinal obstruction in newborns. We report a case of a neonate who developed bilious vomiting two days after birth and failed to pass meconium after birth. Abdominal X-ray examination showed that the stomach and duodenal bulb were filled with gas and expanded, thus causing the \u0026quot;double bubble sign\u0026quot;. The patient\u0026rsquo;s characteristics were consistent with the duodenal network. The stomach and the first and second parts of the duodenum were dilated, giving it a windsock appearance. The patient\u0026apos;s characteristics were also consistent with the duodenal web (Fig. 5a \u003cstrong\u003eand b\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eAn incarcerated inguinal hernia can lead to bowel obstruction, strangulation, and infarction. Irreducibility is an ever-present risk with untreated inguinal hernia, and its management remains a key component of pediatric surgical practice. When hernias are irreducible, morbidity and mortality are increased. A 26-day-old newborn was admitted to the hospital due to irreducible inguinal hernia. He presented with irritability, loss of appetite, vomiting, abnormal defecation, left groin tenderness, and scrotal swelling. There were fluid-filled, dilated loops of the small intestine in an incarcerated inguinal hernia that was revealed using scrotal ultrasound. Abdominal ultrasound imaging showed fluid-filled, dilated small bowel loops secondary to incarcerated inguinal hernia (Fig. 6a \u003cstrong\u003eand b\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe patients in all the above cases were discharged successfully after surgery.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study shows that HD was the most common cause of neonatal intestinal obstruction leading to surgery at our center. The incidence of HD is approximately 1 in 2,000 to 5,000 live births, and the male-to-female ratio is approximately 4 to 1. HD may be genetic. The most common site of this disease is the sigmoid colon, accounting for 75% of cases; only the rectum is affected in about 20%; the entire large intestine is affected in about 2%. The most unfortunate case is when the whole intestine is deficient in ganglion cells (total aganglionosis), accounting for about one percent of cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHD is one of the common congenital diseases treated in pediatric surgery. Careful observation and treatment by a responsible physician are required, as in some unfortunate cases, babies develop colitis or intestinal rupture soon after birth. The occurrence of sepsis can lead to death, so urgent and appropriate treatment can reduce its mortality, as can increased alertness to the possibility of diagnosing this disease, appropriate preoperative treatment and surgery, and successful postoperative care. Rates and complications: If a newborn does not defecate within 48 hours after birth, the possibility of suffering from congenital intestinal obstruction is greatly increased. Mechanical bowel obstruction (e.g., esophageal atresia or intestinal atresia) and functional bowel obstruction (e.g., HD) should be considered. Newborns with intestinal obstruction generally experience abdominal distension and vomiting; unsatisfactory weight gain, or even weight loss; and a significant reduction in activity. The incidence rate of preoperative intestinal perforation in HD neonates is 6.0%, which mainly occurs in short-segment and long-segment HD. Perforations are mainly located in the normally innervated upstream segments. Prompt surgical intervention, especially ostomy, results in good outcomes for most patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, the second cause of bowel obstruction leading to neonatal surgery was intestinal malrotation. Congenital volvulus is mainly caused by the sequential rotation of the duodenum and large intestine along the superior mesenteric artery in the abdominal cavity to achieve normal positioning during the embryonic period; however, if abnormalities occur during the rotation, malrotation may occur. This may cause the intestines to continuously twist, leading to the partial or complete obstruction of the gastrointestinal tract. Once the intestines are twisted tightly, blood circulation will stop, and intestinal necrosis will occur, leading to peritonitis or even sepsis, which is life-threatening. During the disease process, if detected early, the intestines can be loosened through surgery; if the intestines are already necrotic, the necrotic parts can be removed; however, if too much is removed, short bowel syndrome will occur, resulting in the inability to absorb food in the future. Inadequate nutrition may lead to related complications. If volvulus is confirmed, the sooner surgery is performed, the less likely complications will arise; prognosis will vary based on the site and length of resection.\u003c/p\u003e \u003cp\u003eUltrasound offers advantages such as accessibility, portability, the absence of ionizing radiation, and the ability to identify alternative diagnoses, and it is beginning to attract widespread attention and consideration in the literature [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Ultrasonography has the advantage of enabling flexible multi-section dynamic assessment and is a valuable tool for diagnosing and determining the cause of intestinal obstruction in neonates. The accuracy of ultrasound in diagnosing intestinal obstruction is 91%, and that in diagnosing the cause of intestinal obstruction is 84% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].Laparoscopic correction of midgut malrotation does not increase the risk of postoperative volvulus and reduces the incidence of adhesive small bowel obstruction [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The mean time to symptom onset in our patients was 3.85 days, which is consistent with most previous studies.\u003c/p\u003e \u003cp\u003eOur results showed that the third cause of bowel obstruction leading to neonatal surgery is CDH. This is a rare congenital disease (according to statistics, the incidence rate is about 1/2000 to 1/5000) caused by the underdevelopment of the diaphragm during the embryonic period (about 7 to 10 weeks of pregnancy), which causes the abdominal organs to slide into the chest cavity, thus leading to pulmonary hypoplasia and altered pulmonary vascular development. The abnormal development of lung tissue and blood vessels leads to poor ventilation and persistent pulmonary hypertension. Common symptoms include dyspnea, shortness of breath, hypoxia, cyanosis, and chest asymmetry on both sides. In addition, due to abdominal organs (such as intestines, stomach, and liver) sliding into the chest or abdomen, the abdomen may be sunken, or even intestinal obstruction, torsion, and necrosis may occur. The diagnosis of CDH is the most important predictor of sepsis and death on arrival, so steps should be taken for early recognition and aggressive treatment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Small bowel obstruction is a common complication after CDH repair, resulting in significant morbidity and potential mortality. There were no cases of such complications in our study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study found that the fourth cause of bowel obstruction leading to neonatal surgery is duodenal atresia or stenosis. Patients with duodenal atresia may develop high intestinal obstruction within hours of birth, with vomiting as the main symptom. More than 90% of patients have bile in their vomitus. Due to the high location of the obstruction, there will be no obvious abdominal distension, but dehydration, electrolyte imbalance, and metabolic alkalosis will soon occur. Symptoms in patients with duodenal stenosis appear slowly, and vomiting symptoms tend to become more pronounced with increased feeding. Patients with small intestinal atresia may also experience bile-containing vomiting clinically, but the abdominal distension is much more severe than that in patients with duodenal atresia. In general, the more severe the bloating, the lower the obstruction is. Consistent with other reports, duodenal atresia is the most common type of intestinal atresia, followed by ileal atresia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. After excluding midgut volvulus, segmental volvulus should be considered one of the differential diagnoses in all infants with bilious vomiting, especially in the presence of fetal ultrasound abnormalities and abdominal distension [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, patients with congenital intestinal obstruction often have no meconium or only a small amount of meconium after birth. Preoperative treatment includes using an indwelling gastric tube for gastric decompression to avoid aspiration pneumonia caused by vomiting and reduce abdominal distension, thus quickly correcting dehydration and electrolyte and metabolic imbalances. In this case, broad-spectrum antibiotics are administered intravenously. In principle, end-to-end anastomosis of the intestine is generally performed to restore the smooth flow of the intestine. For small bowel atresia, the resection of part of the hypertrophic proximal end is often necessary to avoid postoperative functional obstruction. It is also necessary to ensure the patency of the distal intestine during surgery, and the possibility of multiple small intestinal atresia cannot be ignored. Duodenal stenosis caused by annular pancreas is usually treated with side-to-side duodenal anastomosis, but if this is difficult, duodenojejunal anastomosis can also be performed. For stenosis caused by the diaphragm in the intestine, the intestine can be incised, the diaphragm cut off, and the intestinal incision sutured. It is not necessary to remove the narrowed portion of the intestine [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In recent years, minimally invasive surgery has been proven to be feasible and safe for the treatment of duodenal obstruction, with results comparable to traditional open surgery. Its effectiveness can be significantly improved with proper training [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMeconium ileus occurs in 12\u0026ndash;20% of newborns diagnosed with cystic fibrosis and is often the first manifestation of the disease; it is defined as perinatal mechanical small bowel obstruction caused by concentrated meconium in the terminal ileum. Newborns with cystic fibrosis and meconium intestinal obstruction are treated very differently and according to different national standards [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. If a newborn has intestinal obstruction and does not pass meconium within 48 hours after birth, meconium intestinal obstruction should be highly suspected. To date, only seven cystic fibrosis patients (from six different families) have been reported in Taiwan [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe incidence of ARM is about 1/4000 newborns, including abnormalities of varying degrees from simple low-level abnormalities to complex cloacal malformations. Children with ARM suffer from a variety of medical conditions. Early complications after corrective surgery are common. Intensive care for complex and elective corrective procedures for ARM remains a critical quality-of-care issue given the large number of hospitals and extremely low caseloads [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Clinically, ARM is classified into the low type and high type. Twenty-four hours after birth, a careful observation of the perineum is the most important. Common combined abnormalities include congenital heart disease, urinary tract abnormalities, spinal abnormalities, etc. High-position abnormalities require a colostomy first, and the ideal stoma is in the descending colon. Posterior sagittal anorectoplasty is currently the most popular surgical method due to its direct observation and repair of abnormalities and fewer postoperative complications.\u003c/p\u003e \u003cp\u003eThe presence of bilious vomiting and contrast abnormalities in the neonate may represent malrotation; nevertheless, adrenal hemorrhage is a rare but important differential diagnosis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Ultrasound remains an important screening tool for the evaluation of intestinal obstruction in newborns. The main ultrasound findings of intestinal obstruction include the differential dilatation of bowel loops, intestinal wall thickening, free fluid, and vascular abnormalities [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Laparoscopically assisted surgery is a safe and effective alternative to traditional open surgery for the treatment of pediatric incarcerated inguinal hernia. Its advantages include less trauma, faster recovery, shorter hospital stay, and fewer complications [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Prompt diagnosis, intervention, and implementation of appropriate management methods are important to improve the prognosis of neonates with intestinal obstruction. The timing of surgical intervention is a major predictor of complications of intestinal obstruction in neonates, and the prompt diagnosis and prompt treatment of these infants can significantly improve outcomes. Initial presentation and postoperative complications significantly influence the morbidity and mortality associated with the neonatal treatment of intestinal obstruction [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCongenital or acquired intestinal obstruction syndrome is the most common and severe causes of vomiting in newborns and the need for emergency treatment.\u003c/p\u003e \u003cp\u003eKey extraintestinal causes of vomiting include brain tumors, meningitis, and inborn errors of metabolism. It is important to recognize red flags for urgent evaluation of vomiting, including nocturnal vomiting that awakens the patient, weight loss, hematemesis (especially during the first episode of vomiting), recurrent bilious vomiting, abdominal distension, absence of tympanic bowel sounds, and changes in mental status[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIntestinal obstruction is a common surgical emergency in neonates that often requires early diagnosis and appropriate treatment. However, when treatment or surgery is delayed, it can sometimes result in patients going into shock, which can even be life-threatening. Symptoms of intestinal obstruction in newborns may include the following: vomiting (with or without bile-staining material), abdominal distension, loss of appetite, and decreased mobility. These infants often suffer from electrolyte imbalances, acidosis, and fluid shock, which require aggressive treatment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eInfants with unexplained gastrointestinal symptoms must be investigated for the possibility of congenital anomalies of the gastrointestinal tract. Conventional radiology remains very useful in diagnosing abnormalities of the gastrointestinal tract [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The treatment of intestinal obstruction in newborns requires collaboration between neonatologists and pediatric surgeons to determine the correct diagnosis and proceed with appropriate treatment [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. With early intervention, cases of intestinal obstruction have lower morbidity and mortality. Outcomes depend in part on congenital comorbidities and delays in diagnosis and treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe thank Mr. Bing-Han Yang for his unremitting efforts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChief of Pediatrics, Department of Pediatrics, Cathay General Hospital,Taipei, Taiwan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLung-Huang Lin\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResident doctor, Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYi-Yang Chiu\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAttending Physician, Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYuan-Ci Chen , Su-Ching Hu\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eL.H. L., Y.Y. C. and Y.C.C. made study conception and design. L.H. L., Y.Y. C., Y.C.C. and S.C.H. acquired data. L.H. L. and S.C.H. analyzed and interpreted data. L.H. L. drafted the manuscript. L.H. L. and S.C.H. revised critically. L.H. L. submitted the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Lung-Huang Linor Su-Ching Hu.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval for this study was obtained from the institutional review board (IRB) of the Cathay General Hospital, Taipei, Taiwan. (Approval No. CGH-P113079). This study adhered to the principles of good clinical practice and the Declaration of Helsinki, ensuring full compliance with patient data protection and privacy standards.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSilva Santos \u0026Iacute;, Pinto F, Rocha G, Pissarra S (2023) Vomiting in neonates. J Pediatr Neonat Individual Med,12(2),e120201.\u003c/li\u003e\n \u003cli\u003eVerma A, Rattan KN, Yadav R (2016) Neonatal intestinal obstruction: a 15 year experience in a tertiary care hospital.\u003cem\u003e\u0026nbsp;\u003c/em\u003eJ Clin Diagn Res, 10(2), SC10-13.\u003c/li\u003e\n \u003cli\u003eSingh S, Srivastav S, Agarwal N, Nagpure A, Khan TR (2024) Neonatal intestinal obstruction: etiology, management, and outcomes in a tertiary care center. 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Pediatr Radiol. 54(13),2099-2111.\u003c/li\u003e\n \u003cli\u003eKedoin C, Muto M, Nagano A, Matsui M, Sugita K, Baba T, Miyoshi K, Masuya R, Murakami M, Yano K, Onishi S, Harumatsu T, Yamada W, Yamada K, Matsukubo M, Kawano T, Kuda M, Nakame K, Torikai M, Ieiri S (2024) Notable clinical differences between neonatal and post-neonatal intestinal malrotation: a multicenter review in southern Japan. J Pediatr Surg, 59(4), 566-570.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGuo B, Pang L, Liu C, Chen X, Qiao Q, Zhang C (2023) Ultrasonic Diagnosis of Intestinal Obstruction in Neonates-Original Article. Diagnostics (Basel)\u003cem\u003e,\u003c/em\u003e13(5),995.\u003c/li\u003e\n \u003cli\u003eJohnston WR, Hwang R, Mattei P (2024) Laparoscopic versus open Ladd rocedure for midgut malrotation. J Pediatr Surg, 59(12), 161673.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRahman NA, Abdullah MY, Abidin M\u0026apos;Z, Nah SA; MYPaedSurg Research Collaboration (2024) Burden and mortality of congenital gastrointestinal anomalies: insights from a nationwide cohort study. Pediatr Surg Int, 40(1), 270.\u003c/li\u003e\n \u003cli\u003eSchmoke N, Cali F, Wilken T, Midura D, Nemeh C, Fan W, Khlevner J, Duron V (2024) Small bowel bstruction following congenital diaphragmatic hernia repair-Incidence and risk actors. Am Surg, 90(12), 3223-3228.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKoenig SM, Russell RT, Quevedo OG, Chen MK (2024) Intestinal atresias: a ten-year evaluation of outcomes. J Surg Res\u003cem\u003e,\u0026nbsp;\u003c/em\u003e296,130-134.\u003c/li\u003e\n \u003cli\u003eCasalino M, Miscia ME, Lauriti G, Gauda E, Zani A, Zani-Ruttenstock E (2024) Neonatal intestinal segmental volvulus: what are the differences with midgut volvulus? Eur J Pediatr Surg, 34(1), 9-19.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSingh V, Pathak M (2016) Congenital neonatal intestinal obstruction: retrospective analysis at tertiary care hospital.\u003cem\u003e\u0026nbsp;\u003c/em\u003eJ Neonatal Surg, 5(4), 49.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFarrokhkhani P, Farhadi R, Ala S, Mousavi SA (2023) Etiology and outcome of intestinal obstruction in neonates: a 5-year investigation of admitted cases from a tertiary neonatal intensive care unit in northern Iran. Clin Med Insights Pediatr,17,11795565231196771.\u003c/li\u003e\n \u003cli\u003eBethell GS, Neville JJ, Johnson MJ, Turnbull J, Hall NJ (2024) Congenital duodenal obstruction repair with and without transanastomotic tube feeding: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed,\u003cem\u003e\u0026nbsp;\u003c/em\u003e109(2), 182-188.\u003c/li\u003e\n \u003cli\u003eCazares J, Col\u0026iacute;n-Garnica J, Cant\u0026uacute;-Reyes JA, Sepulveda-Valenzuela M, Torres-Salas M, de la Rosa-Bustamante E, Guillen-C\u0026aacute;rdenas A (2024) Minimally invasive surgery for duodenal obstructions, 10 years of experience in a single center. J Pediatr Surg, 59(12),161700.\u003c/li\u003e\n \u003cli\u003eDonos MA, Ghiga G, Trandafir LM, Cojocaru E, Țarcă V, Butnariu LI, Bernic V, Moroșan E, Roca IC, M\u0026icirc;ndru DE, Țarcă E\u0026nbsp;(2024)\u0026nbsp;Diagnosis and Management of Simple and Complicated Meconium Ileus in Cystic Fibrosis, a Systematic Review. Diagnostics (Basel)\u003cem\u003e,\u003c/em\u003e14(11), 1179.\u003c/li\u003e\n \u003cli\u003eSellouti M, Agadr A, Abilkassem R (2024) Complicated meconium ileus in a male neonate with cystic fibrosis: Case report. Radiol Case Rep\u003cem\u003e,\u003c/em\u003e20(1), 187-190.\u003c/li\u003e\n \u003cli\u003eChen HJ, Lin SP, Lee HC, Chen CP, Chiu NC, Hung HY, Chern SR, Chuang CK (2005) Cystic fibrosis with homozygous R553X mutation in a Taiwanese child. J Hum Gene, 50(12), 674-678.\u003c/li\u003e\n \u003cli\u003eWilms M, Jenetzky E, M\u0026auml;rzheuser S, Busse R, Nimptsch U (2024) Treatment of anorectal malformations in German hospitals: analysis of national hospital ischarge data from 2016 to 2021. Eur J Pediatr Surg, 34(6), 501-511.\u003c/li\u003e\n \u003cli\u003eBickerstaff EA, Ashour K, Fawkner-Corbett D (2024) Neonatal adrenal haemorrhage presenting with bowel obstruction in a term neonate. BMJ Case Rep, 17(11), e260907.\u003c/li\u003e\n \u003cli\u003eSalman R, Mertiri L, Seghers VJ, Schiess DM, Nguyen HN, Sher AC, Sammer MBK (2024) Ultrasound imaging of bowel obstruction in neonates. J Ultrasound, 27(2), 407-417.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLi X, Zhou M, Wang S, Zhang C (2024) The role of multimodal ultrasound in diagnosis of fetal bowel dilatation and prediction of adverse neonatal outcomes: A study of 86 cases in a series of 43,562 births\u003cem\u003e.\u0026nbsp;\u003c/em\u003eHeliyon,\u003cem\u003e\u0026nbsp;\u003c/em\u003e10(5), e27455.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZhang G, Ding H, Wang D, Guo F, Hu B (2024) Pediatric incarcerated inguinal hernia: Traditional open or laparoscopic-assisted approach? Medicine (Baltimore),103(18),e37810.\u003c/li\u003e\n \u003cli\u003eOgundoyin OO, Olulana DI, Lawal TA, Ajao AE (2019) Outcome of management of neonatal intestinal obstruction at a tertiary center in Nigeria. Niger J Surg,\u003cem\u003e\u0026nbsp;\u003c/em\u003e25(2), 163-166.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZhang Y, Gao W, Zuo W, Yu C (2024) Treating neonatal intestinal obstruction with ostomy in continuity: a single-center comparative study. Transl Pediatr, 13(9), 1600-1607.\u003c/li\u003e\n \u003cli\u003eVinocur DN, Lee EY, Eisenberg RL\u0026nbsp;(2012) Neonatal intestinal obstruction. AJR Am J Roentgenol,\u003cem\u003e\u0026nbsp;\u003c/em\u003e198(1), W1-10.\u003c/li\u003e\n \u003cli\u003eTreider M, Granheim S, Engebretsen AH, Pripp AH, R\u0026oslash;kkum H, Skari H, S\u0026aelig;ter T, Bj\u0026oslash;rnland K\u0026nbsp;(2023) Congenital duodenal obstruction: national trends in management and outcomes during the last quarter of a century in Norway.\u003cem\u003e\u0026nbsp;\u003c/em\u003eEur J Pediatr Surg, 33(6),503-509.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 is available in the Supplementary Files section.\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. The age at which symptoms of various diseases appear.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eDisease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026lt;7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7-13 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e14-20 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e21-28 days\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eHirschsprung disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eMalrotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eCongenital diaphragmatic hernia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eDuodenal obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eMeconium ileus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eMeckel diverticulum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eAnorectal malformation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eEsophageal atresia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eInguinal hernia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003ePyloric stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eJejunal stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eDuplication cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e84.15 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e4.9 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7.9 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2.9 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hirschsprung disease (HD), Malrotation gut Anorectal malformation (ARM), Gastrointestinal obstruction Congenital diaphragmatic hernia (CDH), Idiopathic hypertrophic pyloric stenosis (IHPS), Neonate","lastPublishedDoi":"10.21203/rs.3.rs-6179755/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6179755/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGastrointestinal obstruction in newborns is a life-threatening condition caused by anatomical abnormalities that lead to failure to defecate. This is the most common surgical emergency for newborns. Prompt diagnosis, intervention, and implementation of appropriate management methods are important to improve outcomes in neonates with intestinal obstruction. This study aimed to explore the clinical characteristics and causes of gastrointestinal obstruction in a tertiary neonatal intensive care unit in Taiwan. Neonatal clinical and demographic characteristics, final diagnosis, surgical complications, and mortality were recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a retrospective study conducted in a tertiary care medical center from May 2007 to November 2024. A total of 101 neonatal patients younger than 28 days of age who presented with gastrointestinal obstruction and underwent surgical intervention were enrolled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 101 newborns were included in this study, with a male-to-female ratio of 1.8:1 and an average age of 4.4 days. The gestational age ranged from 24 to 40 weeks, with an average of 32.3 weeks, including 58 (57.4%) full-term infants and 43 (42.6%) premature infants. Birth weight ranged from 633 to 3675 g (average = 2425 g). Initial clinical manifestations included abdominal distension, bilious vomiting, and decreased activity levels. The mean age at presentation was 5 days, and the most common cause of intestinal obstruction was Hirschsprung disease (HD), which was observed in 23 (22.7%) cases. Other causes included 16 cases (15.8%) of malrotation, 11 cases (10.9%) of congenital diaphragmatic hernia (CDH), 11 cases (10.9%) of duodenal obstruction, 9 cases (8.9%) of meconium ileus, 8 cases (8%) of Meckel diverticulum, 6 cases (5.9%) of anorectal malformation (ARM), 6 cases (5.9%) of esophageal atresia, 3 cases (2.9%) of inguinal hernia, 2 cases (1.9%) of idiopathic hypertrophic pyloric stenosis (IHPS), 1 case (0.9%) of jejunal atresia, 1 case (0.9%) of duplication cyst, and 4 other cases (3.9%).\u003c/p\u003e\n\u003cp\u003eAfter surgical correction, five patients died due to necrotizing enterocolitis, ileal perforation,and sepsis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMorbidity and mortality from neonatal gastrointestinal obstruction have improved in recent years. In this study, we found that prenatal diagnosis, early referral, improved surgical techniques, and adequate staffing and postoperative care are critical for good outcomes.\u003c/p\u003e","manuscriptTitle":"Neonatal gastrointestinal obstruction : 17 years of single-institution experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-20 20:26:41","doi":"10.21203/rs.3.rs-6179755/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3263c059-82aa-418b-a29f-7f02845b0905","owner":[],"postedDate":"March 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-11T19:08:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-20 20:26:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6179755","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6179755","identity":"rs-6179755","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}