Diffuse Bowel Dilation as a Novel Diagnostic Marker for Jejunoileal Atresias: A Machine Learning Approach Integrating Risk Factors

Diffuse Bowel Dilation as a Novel Diagnostic Marker for Jejunoileal Atresias: A Machine Learning Approach Integrating Risk Factors | 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 Diffuse Bowel Dilation as a Novel Diagnostic Marker for Jejunoileal Atresias: A Machine Learning Approach Integrating Risk Factors Qi Li, Yang Li, Jingwei Liu, Haifang Wu, Yongqi Li, Guowei Tao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6751021/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 Jejunoileal atresias (JIA) are congenital intestinal obstructions with a complex etiology, where timely surgery is crucial but prenatal diagnosis is challenging due to overlapping ultrasound signs with other disorders. This study aimed to identify key prenatal ultrasound and clinical predictors of JIA in fetuses with bowel dilation, with a focus on novel morphological markers. Methods We performed a retrospective analysis of cases from From January 1, 2018, to November 15, 2024, with fetal bowel dilation. Demographic information and ultrasound data were collected. The Lasso-logit model was employed to screen the final variables. Moreover, the marginal propensity diagrams were utilized to visually display the change in the probability of JIA occurrence with the variation of these variables. Results Dilation type, polyhydramnios, and bowel diameter were primary explanatory variables in the model, with odds ratios of 320.86, 108.85, and 55.09 respectively. JIA probability exceeds 50% when the normalized bowel diameter reaches 1.1 (about 34.4 mm actual diameter).With a specific bowel diameter, JIA probability is highest when both diffuse dilation and polyhydramnios exist, followed by only diffuse dilation, and lowest without both. Conclusions Diffuse bowel dilation, larger bowel diameter, and polyhydramnios are critical ultrasound markers for JIA. The proposed Lasso-Logit model highlights diffuse dilation as a novel, independent diagnostic criterion, addressing gaps in prenatal specificity. Diffuse bowel dilation Jejunoileal atresias Prenatal diagnosis Ultrasound markers Congenital obstruction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Jejunoileal atresias (JIA), a congenital obstruction in the jejunum or ileum with an incidence ranging from 1.3 to 2.8 cases per 10,000 newborns 1 – 4 , is distinct from duodenal atresias (DA) characterized by lumen cavitation obstruction and has a highly complex etiology. The primary cause is the rupture of corresponding branches of the mesenteric artery, which can be triggered by various factors including mechanical disruptions like intussusception, perforation, torsion, hernia, and vascular-related incidents such as thromboembolism 5 – 9 . Moreover, emerging research has indicated potential genetic contributions, with Gupta et al. revealing a link between the expression of ITGA2 873 G/A and NPPA 2238 T/C nucleotide sequences and an increased JIA risk 10 . This intricate web of potential causes highlights the need for comprehensive research on JIA to better understand its origin and develop more effective diagnostic and treatment strategies. The timing of surgical intervention for patients with JIA is crucial for determining their mortality and prognosis. Timely surgery is essential. Delaying the operation can lead to a series of severe consequences, including short bowel syndrome, small intestine necrosis, and dependence on total parenteral nutrition 11 – 13 . Despite its crucial significance, the prenatal diagnosis of JIA remains a challenging task. Compared to DA, the diagnosis of JIA is generally more challenging, despite both being intestinal atresias. DA is easier to diagnose prenatally, mainly due to distinct features like the 'double bubble sign' and polyhydramnios.In contrast, JIA is more difficult to identify prenatally. It seldom causes significant amniotic fluid volume changes, and the distal location of the intestinal obstruction complicates ultrasound diagnosis. Prenatal ultrasound findings related to JIA, such as intestinal dilation, enhanced intestinal echogenicity, and polyhydramnios, lack specificity as they can also be seen in other congenital gastrointestinal obstructions, including anal atresias, meconium ileus, midgut torsion or malrotation, intestinal duplication, and congenital megacolon 14 – 18 . Overall, the overlapping features of JIA with other diseases make its prenatal diagnosis extremely difficult, underscoring the urgent need for more specific diagnostic methods. In our clinical work, we have observed that for fetuses with JIA, besides the ultrasonographic indicators such as bowel dilation, increased bowel echogenicity, and polyhydramnios, the morphological characteristics of bowel dilation may also be helpful in diagnosing JIA. Therefore, our research aim was to analyze the clinical and ultrasonographic features associated with JIA among fetuses with bowel dilation, providing valuable information for screening and treatment decision-making in high-risk populations. Methods Study design and Participants This retrospective study of fetuses with dilated intestines, excluding those with suspected duodenal obstruction, loss of follow-up, induced labor, and other extraintestinal abnormalities. The study focused on fetuses with dilated intestines identified during routine prenatal ultrasound scans and other hospital referrals between From January 1, 2018, to November 15, 2024. The diagnostic gold standard for JIA was postpartum surgery and pathological results, categorizing fetuses with intestinal dilation into normal and suspected JIA based on postnatal diagnostic outcomes. The study used Philips IU22 and EPIQ7 instruments equipped with 3 ~ 5 MHz transducers. Ethical approval for this study was obtained from the ethics committee (No.KYLL-202410-025). Informed consent was obtained from all participants. Identifying data has been removed. All methods were performed in accordance with the relevant guidelines and regulations. Clinical and Ultrasound Variables Demographic data included maternal age, maternal body mass index (BMI), infant gender, gestational age (GA) and weight at birth, as well as the GA diagnosed on the first and last ultrasound examination. The ultrasound data to be recorded included the type of bowel dilation, the widest diameter of dilation, enhanced intestinal echo, abdominal calcification, ascites, amniotic fluid volume assessment, and the presence of other intestinal-related abnormalities. Additionally, the weekly rate of bowel dilation was calculated. In our study, fetal bowel dilation was defined as a dilation of the bowel length of at least 15mm and/or a diameter of at least 7mm 19 – 21 . The classification of bowel dilation was divided into segmental and diffuse types, based on the distinct morphologies observed in ultrasound images. Diffuse bowel dilation was characterized by a honeycomb-like appearance, occupying approximately two-thirds of the abdomen. In contrast, segmental bowel dilation referred to a smaller area of dilation, accounting for less than one-third of the total abdomen. The morphology of bowel dilation may vary with increasing gestational age, and in such instances, the type of bowel dilation observed during the final ultrasound examination was taken into consideration. The measurement of the widest diameter of bowel dilation was determined as the distance between the inner walls of the bowel, excluding the bowel wall itself. Bowel echogenic enhancement was identified by increased brightness in the fetal intestines, with brightness equal to or greater than that of the iliac wings 22 . The ultrasound characteristics mentioned above were illustrated in Fig. 1 . The calculation of the bowel dilation rate involved determining the difference in bowel diameter measurements between two consecutive examinations and dividing this by the corresponding increase in gestational weeks. The interpretation of ultrasound reports should be independently reviewed by two ultrasound physicians (Q.L.and H.F.W.) with more than five years of experience. In case of any objections to the results, a physician (G.W.T.) with more than ten years’ experience would make the final determination. The process of obtaining case data involved a team of two researchers (Y.L. and J.W.L.) who worked together to retrieve, organize, and verify the data to ensure its reliability, completeness, and accuracy. Follow up All fetuses were followed up until one month after birth. For live births, a postpartum assessment was conducted, and neonatal physical signs were recorded, including whether there was vomiting or bowel movement within the first 24 hours after birth, abdominal distension, and respiratory status, along with imaging examinations. If any of these results were abnormal, a consultation with a pediatric surgeon was considered to evaluate the possibility of JIA, and surgical treatment was performed with the consent of the patient's family. The gold standard for diagnosing JIA is direct intraoperative observation and postoperative pathological results. Jejunal atresias is defined as an obstruction occurring within 60cm of the ligament of Treitz; if the atresias is located more than 60 cm from the ligament of Treitz, it is classified as ileal atresias 23 . Model development We applied the lasso-logit model as our empirical research method to screen the final ultrasound variables and identify the features most closely associated with Jejunoileal atresias in model development. The loss function of the Lasso-Logit model took the following form: $$\:\underset{\beta\:}{\text{min}}\:-\sum\:_{i=1}^{N}{y}_{i}\:log\left[{\Lambda\:}\left({X}_{i}^{{\prime\:}}\beta\:\right)\right]+(1-{y}_{i})log\left[1-{\Lambda\:}\left({X}_{i}^{{\prime\:}}\beta\:\right)\right]+\lambda\:\left|\beta\:\right|$$ Where \(\:{\Lambda\:}\left(·\right)\) is the logistic link function; X is the explanatory variable matrix, the elements of X are ‘ Dilation type ’, ‘ Intestinal hyperechoic ’, ‘ Abdominal calcification ’, ‘ Ascites ’, ‘ Polyhydramnios ’, ‘ Abdomen circumference ’, ‘ Bowel diameter ’, ‘ Dilated rate ’; \(\:\mathbf{y}\) is the binary dummy variable indicating whether the patient has jejunoileal atresias; \(\:{\lambda\:}\left|{\beta\:}\right|\) is the penalty term.To determine the statistical significance of regression coefficients, we resample the original dataset by adapting bootstrap and implementing the percentile method to test the statistical significance of coefficients. Firstly, we conduct bootstrap resampling 1000 times to formulate the bootstrap density of coefficients. After that, we select the percentiles at the 1% significance level to construct the interval [ \(\:{{\beta\:}}_{0.5\text{\%}}^{\ast\:}\:,\:{{\beta\:}}_{99.5\text{\%}}^{\ast\:}\) ], in which the coefficient is statistically significant at the 1% level if 0 is not in the interval. Statistical analysis To assess data normality, we used the Quantile-Quantile plot (Q-Q plot). Normally distributed variables were presented as mean ± standard deviation (SD) and were compared between two groups using t -tests. Non-normally distributed variables were reported as median and interquartile intervals (IQR) and analyzed with the Mann-Whitney U-test. Categorical variables were expressed as frequency and percentage, and tested using the Chi-square test or Fisher’s exact test. Statistical significance was set at P < 0.05. For missing data, we used regression imputation. Lasso-logit regression analysis was conducted in R version 4.4.1, with the "glmnet" package for statistical analyses. Results Participants From January 1, 2018, to November 15, 2024, a total of 323 fetuses with bowel dilation were included. Among them, 102 cases were excluded for suspected duodenal obstruction (based on the 'double bubble sign'), 30 for induced abortion, 24 for associated extraintestinal anomalies (e.g., cardiac or urinary malformations), and 90 for incomplete data or loss to follow-up. Among the 77 cases, 50 cases were diagnosed as normal newborns based on postnatal physical examinations and imaging results. Surgical intervention was required for 27 cases, of which 23 were diagnosed with jejunoileal atresias through intraoperative and pathological findings. Specifically, cases included isolated jejunal atresias (n = 7), jejunal atresias with other anomalies (n = 5), isolated ileal atresias (n = 6), ileal atresias with other anomalies (n = 4), and combined jejunoileal atresias (n = 1). Additionally, in the remaining 4 cases, intestinal dilation was found to be caused by other intestinal anomalies, including 1 case of intestinal duplication, 1 case of intestinal malrotation with midgut volvulus, and 2 cases of jejunum stenosis. Finally, our study included 50 normal and 23 JIA fetuses.The flowchart was shown in Fig. 2 . Baseline characteristics of the 73 participants included maternal age (32.55 ± 4.86 years), BMI (27.72 ± 3.56 kg/m²), gestational age at first ultrasound (31.82 ± 4.05 weeks),and the last (37.49 ± 1.84 weeks). In terms of pregnancy history, the median and interquartile range for the number of pregnancies and deliveries were (2.00 (1.75,3.00); 1.00 (0.00,1.00)), respectively. For the mode of delivery, the percentage of vaginal deliveries (50.68%,37/73) and cesarean deliveries (49.32%,36/73) were recorded. The gender distribution of the infants was (35.62%,26/73) boys and (64.38%,47/73) girls. For the Apgar scores of newborns, the median and IQR were all (10.00(10.00, 10.00)) at 1 minute, 5 minutes, and 10 minutes. The gestational age at birth was 38.28 ± 1.53 weeks, and the birth weight was 3188.62 ± 398.50 g. In the univariate analysis, we classified 73 participants with bowel dilation into JIA and control groups based on the pathological gold standard. Statistical analysis revealed significant differences ( P < 0.05) in clinical and ultrasound features, including gestational age at birth, Apgar scores, the pattern of bowel dilation, intestinal hyperechoic, ascites, polyhydramnios, intestinal diameter, and the rate of intestinal dilation, between the two groups, indicating a potential correlation with JIA (Table 1 ). Table 1 Clinical and ultrasound findings of normal and jejunoileal atresias fetuses JIA (n = 23) Normal (n = 50) P Clinical Variables Maternal age (years) 32.04 ± 5.26 32.72 ± 4.74 0.781 BMI (kg/m²) 29.65 ± 2.83 27.02 ± 3.61 0.215 Gravidity (n) 2.00 (1.00,3.00) 2.00 (1.70,4.00) 0.583 Parity (n) 0.00 (0.00,1.00) 1.00 (0.00,1.00) 0.312 Delivery 0.184 Cesarean (n,%) 14 (60.87) 22 (44.00) Vaginal delivery (n,%) 9 (39.13) 28 (56.00) GA at delivery (weeks) 36.96 ± 1.63 38.91 ± 1.03 0.023* Birthweight (g) 3110.87 ± 524.16 3223.98 ± 340.34 0.296 Gender 0.345 Male (n,%) 10 (43.48) 16 (32.00) Female (n,%) 13 (56.52) 34 (68.00) Apgar score 1 minute 10.00 (9.50,10.00) 10.00 (10.00,10.00) <0.001* 5 minutes 10.00 (9.80,10.00) 10.00 (10.00,10.00) <0.001* 10 minutes 10.00 (10.00,10.00) 10.00 (10.00,10.00) 0.003* Ultrasound Variables Dilation type(n,%) <0.001* Segmental 15 (65.22) 50 (100.00) Diffuse 8 (34.78) 0 (0.0) Intestinal hyperechoic (n,%) 8 (34.78) 8 (16.00) 0.074 Abdominal calcification (n,%) 2 (8.70) 0 (0.0) 0.036* Ascites (n,%) 2 (8.70) 0 (0.0) 0.036* Polyhydramnios (n,%) 17 (73.91) 10 (20.00) <0.001* AC (mm) 338.57 ± 23.48 335.60 ± 14.32 0.579 Bowel diameter (mm) 32.0 (24.0, 37.0) 16.0 (14.0,18.0) <0.001* Dilated rate (mm/week) 2.17 (1.40,3.14) 0.89 (0.50,1.50) <0.001* JIA,Jejunoileal atresias; BMI, body mass index; GA, gestational age; AC, abdomen circumference; *, significant differences. Model derivation The independent variables were entered into the lasso-logit model to screen the final ultrasound variables. We employed ridge trace diagrams and cross-validation to determine the optimal lambda value. Figure 3 presents the ridge trace plot, ranking variable importance from highest to lowest: dilation type, polyhydramnios, bowel diameter, intestinal hyperechogenicity, and dilation rate. According to Fig. 3 , the plot stabilizes at log(λ) = -4.814. Consequently, the optimal lambda suggested by the ridge trace was 0.00811. To ensure the robustness of the previous result, we employed cross-validation to identify the lambda value that minimized the loss. Based on the results presented in Table 2 , dilation type, polyhydramnios, and bowel diameter are the primary explanatory variables in the lasso-logit model. The odds ratios for JIA associated with dilation type, polyhydramnios, and bowel diameter are 320.86, 108.85 and 55.09 respectively. Table 2 Lasso-Logit Regression Results Coefficients OR Lower bound (10%) Upper bound (10%) Intercept -4.268 - - - Dilation type 5.771* 320.86 0.037 8.349 Intestinal hyperechoic 0.722 - -1.247 3.722 Polyhydramnios 4.690* 108.85 1.645 7.501 Abdominal calcification - - 0 1.982 Ascites - - 0 2.755 Bowel diameter 4.009* 55.09 1.641 6.581 Dilated rate - - -0.849 2.726 *,Dilation type, Polyhydramnios, and Bowel diameter are the primary explanatory variables in the lasso-logit model Given that these odds ratios are greater than 1, dilation type, polyhydramnios, and bowel diameter exert a positive marginal effect on the risk of JIA. Since variables have been normalized, the value of coefficients is comparable. According to Table 2 , dilation type makes the most substantial contribution to explaining JIA, while polyhydramnios and bowel diameter carry similar weights in the model. Figures 4 and 5 present the marginal propensity diagrams for dilation type, polyhydramnios, and bowel diameter, illustrating the relationship between the explanatory variables of interest and the probability of JIA, while holding all other variables constant. As shown in the Fig. 4 , an increase in the normalized bowel diameter leads to a higher probability of JIA. Given a specific bowel diameter, the probability of JIA is highest when both diffuse dilation and polyhydramnios are present, followed by cases with only diffuse dilation. The lowest probability occurs in the absence of both polyhydramnios and diffuse dilation. The probability of JIA exceeds 50% when the normalized bowel diameter reaches 1.1 (corresponding to an actual diameter of approximately 34.4 mm). Figure 5 illustrates the probability of JIA under different combinations of bowel dilation type and polyhydramnios. Isolated bowel dilation (Dilation type = 1, Polyhydramnios = 0) is associated with an 81.8% probability of JIA, indicating its role as a dominant independent risk factor, whereas isolated polyhydramnios (Dilation type = 0, Polyhydramnios = 1) shows a moderate probability of 60.4%. Ultrasound Features and Prognosis of Jejunal Atresias versus Ileal Atresias According to the pathological results, jejunoileal atresias cases were divided into two groups: the jejunal atresias group and the ileal atresias group. No significant differences are found in polyhydramnios, associated abnormalities, or postoperative short bowel syndrome ( P > 0.05). However, diffuse dilation and postoperative meconium peritonitis are statistically significant ( P < 0.05) (Table 3 ). Table 3 Differences between cases of jejunal and ileal atresia Jejunum atresia(n = 12) Ileum atresia(n = 10) P Prenatal ultrasound findings Polyhydramnios (n,%) 10 (83.33) 6 (60.00) 0.232 Bowel diameter (mm) 34.5 (24.0, 40.0) 29.5 (23.75,38.0) 0.531 Dilation type (n,%) 0.003* Segmental 11 (91.67) 3 (30.00) Diffuse 1 (8.33) 7 (70.00) Intestinal hyperechoic (n,%) 4 (33.33) 4 (40.00) 0.752 Abdominal calcification (n,%) 0 (0.00) 1 (10.00) 0.273 Ascites (n,%) 0 (0.00) 1(10.00) 0.273 Dilated rate (mm/week) 2.17 (1.46,3.11) 1.98 (-0.63,3.63) 0.692 Postoperative condition other intestinal abnormalities(n,%) 5 (41.67) 4 (40.00) 0.938 Midgut malrotation 1 (8.33) 0 (0.00) Congenital intestinal stenosis 2 (16.66) 0 (0.00) Small intestine volvulus 2 (16.66) 4 (40.00) Meconium peritonitis (n,%) 0 (0.00) 4 (40.00) 0.002* Short bowel syndrome (n,%) 3 (25.00) 0 (0.00) 0.096 GA at delivery (weeks) 36.81 ± 1.57 37.30 ± 1.74 0.446 Birthweight (g) 2800 (2600,3575) 3175 (2978,3525) 0.409 GA, gestational age; *,significant differences Discussion This study identified diffuse bowel dilation, polyhydramnios, and larger bowel diameters as key prenatal predictors of JIA in fetuses with bowel dilation. The Lasso - logit model showed that fetuses presenting with diffuse bowel dilation, increased amniotic fluid, and wider bowel diameters were at a higher risk of atresias. Specifically, diffuse bowel dilation was a particularly strong predictor. The identification of diffuse bowel dilation as the strongest predictor of JIA, with an exceptionally high odds ratio of 320.86 in the Lasso-Logit model, represented a significant advancement in prenatal diagnostics. This finding suggested that fetuses exhibiting diffuse intestinal dilation had over 300 times higher odds of developing JIA compared to those without this feature, even after adjusting for confounders such as polyhydramnios and bowel diameter. The associated probability of 81.8% for JIA in cases of isolated diffuse dilation further underscored its clinical relevance as a standalone diagnostic marker.Previous studies on prenatal JIA diagnosis focused on indirect markers such as polyhydramnios, hyperechogenicity, or bowel diameter thresholds 24 . However, these indicators lack specificity and are often confounded by other fetal anomalies (e.g., esophageal atresia or chromosomal disorders). To our knowledge, no prior studies have explicitly proposed diffuse intestinal dilation as an independent diagnostic criterion for JIA. This novel marker addressed a critical gap by directly linking morphological severity (diffuse vs. segmental dilation) to the likelihood of atresia, thereby enhancing diagnostic precision. This study observed that jejunal atresias predominantly manifested as segmental dilation, whereas ileal atresias were characterized by diffuse dilation, potentially reflecting embryological and functional distinctions. Jejunal segmental dilation may arise from localized vascular disruptions or compensatory mechanisms in its wider lumen, while ileal diffuse dilation could result from impaired recanalization or pressure buildup in narrower, meconium-rich segments. Structural differences in intestinal walls (e.g., thinner ileal musculature) may further predispose to diffuse patterns. However, these findings were limited by a small sample size on prenatal ultrasound, necessitating cautious interpretation. Future validation in larger cohorts, combined with fetal MRI or histopathological correlation, is critical to confirm these patterns and elucidate underlying mechanisms. Previous literature has reported the use of intestinal diameter measurements as a tool to differentiate between normal fetuses and those with jejunoileal atresias 21 , 25 , 26 . We observed that fetuses with jejunoileal atresias exhibited larger bowel diameters compared to normal fetuses (32mm vs. 16mm). As the lumen increases, the probability of disease also increases. When the diameter of the luminal diameter is greater than 34.4mm, the probability of disease will be greater than 50%. Bowel diameter can serve as a potential ultrasound indicator for distinguishing normal fetuses from those with jejunoileal atresias, as intestinal obstruction can lead to increased intestinal pressure, resulting in proximal intestinal dilation at the site of obstruction. In contrast, normal fetuses typically maintain a smaller intestinal diameter and do not exhibit significant pressure induced dilation. Univariate analysis showed that fetuses with JIA exhibited a significantly higher weekly bowel dilation rate compared to normal fetuses (2.17mm vs. 0.89mm; P < 0.001), indicating a statistically significant association between dilation rate and JIA. These findings were consistent with prior studies by Raphaële Mangione et al., which also emphasized dilation rate as a diagnostic indicator for JIA. 21 However, in the multivariate logistic regression model, this association was attenuated and lost statistical significance after adjusting for confounders such as dilation type, polyhydramnios, and bowel diameter, suggesting that dilation rate may indirectly reflect obstruction severity through its correlation with static morphological markers (e.g., bowel diameter) rather than acting as an independent predictor. Notably, intestinal lumen widening and accelerated growth rates were not universally observed in all obstructed fetuses. In two exceptional cases, decreased intestinal lumen diameter and negative growth rates were detected during late pregnancy. This phenomenon was attributed to perinatal intestinal rupture caused by excessive dilation, which allowed intestinal contents to leak into the abdominal cavity. The subsequent reduction in intraluminal pressure led to lumen contraction and reversed growth patterns. These cases highlighted the complexity of JIA pathophysiology, where extreme dilation may trigger structural failure, altering typical disease progression. The identification of diffuse bowel dilation as a powerful diagnostic marker for JIA has significant clinical implications. It can potentially enable earlier and more accurate prenatal diagnosis, allowing for better prenatal counseling and more timely postnatal surgical intervention. This may improve the prognosis for affected neonates by reducing the risk of complications such as short bowel syndrome and small intestine necrosis. However, before this information can be confidently used in clinical settings, additional research with larger sample sizes is required to validate these findings and establish more precise diagnostic algorithms. There are still unanswered questions. For example, the underlying mechanisms of why jejunal atresias predominantly show segmental dilation while ileal atresias show diffuse dilation need further exploration. Future research could also focus on validating these findings in larger, multicenter cohorts and integrating other imaging modalities like fetal MRI for more comprehensive diagnosis. Additionally, studies could investigate the combined effects of genetic factors and these ultrasound markers on JIA development. One of the strengths of this study is its use of a well - defined retrospective cohort and a rigorous statistical model (Lasso - logit model) to identify relevant predictors. The clear definition of ultrasound variables and the use of experienced reviewers for ultrasound reports also add to the reliability of the data collection. However, the study has limitations. The relatively small sample size of JIA cases may lead to insufficient statistical power, potentially affecting the generalizability of the results. There is also a risk of observer bias during the image review process, which could impact the consistency of diagnostic assessments. Conclusions This study established diffuse bowel dilation as a groundbreaking diagnostic marker for jejunoileal atresias, demonstrating unparalleled predictive power in prenatal ultrasound. The integration of bowel diameter thresholds and polyhydramnios further refines risk stratification, enabling earlier and more accurate diagnosis. Abbreviations JIA,jejunoileal atresias DA,duodenal atresias Declarations Ethics approval and consent to participate This study was performed in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Qilu Hospital, Shandong University (No.KYLL-202410-025). Informed consent was obtained from all participants.Identifying data has been removed. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions Qi Li : Conceptualization, Methodology, Writing – original draft, Writing – review & editing. Yang Li : Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing. Guowei Tao : Conceptualization, Methodology, Project administration. Jingwei Liu : Data curation, Resources. Haifang Wu : Data curation, Resources. Yongqi Li : Formal analysis, Validation. All authors read and approved the final manuscript. Acknowledgements The study was supported by Natural Science Foundation of Shandong Province, ZR2022QH381 References Rubio EI, Blask AR, Badillo AT, Bulas DI. 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The role of multimodal ultrasound in diagnosis of fetal bowel dilation and prediction of adverse neonatal outcomes: A study of 86 cases in a series of 43,562 births. Heliyon. 2024;10(5):e27455. Lap CC, Voskuilen CS, Pistorius LR, Mulder E, Visser G, Manten G. Reference curves for the normal fetal small bowel and colon diameters; their usefulness in fetuses with suspected dilated bowel. J Matern Fetal Neonatal Med. 2020;33(4):633–8. Mangione R, Voirin-Mathieu E, Yvert M, Fries N, Mousty E, Castaigne V, Muller F, Dreux S, DILDIG Study Group. Fetal intestinal loop dilation: Follow-up and outcome of a series of 133 consecutive cases (the DILDIG study). Prenat Diagn. 2023;43(3):328–38. Laird A, Shekleton P, Nataraja RM, Kimber C, Pacilli M. Incidence of gastro-intestinal anomalies and surgical outcome of fetuses diagnosed with echogenic bowel and bowel dilation. Prenat Diagn. 2019;39(12):1115–9. Tongsin A, Anuntkosol M, Niramis R. Atresias of the jejunum and ileum: what is the difference. J Med Assoc Thai. 2008;91(Suppl 3):S85–89. Virgone C, D'antonio F, Khalil A, Jonh R, Manzoli L, Giuliani S. Accuracy of prenatal ultrasound in detecting jejunal and ileal atresia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;45(5):523–9. Silva P, Reis F, Alves P, Farinha L, Gomes MS, Câmara P. Fetal Bowel dilation: A Sonographic Sign of Uncertain Prognosis. Case Rep Obstet Gynecol 2015; 2015:608787. John R, D'Antonio F, Khalil A, Bradley S, Giuliani S. Diagnostic Accuracy of Prenatal Ultrasound in Identifying Jejunal and Ileal Atresias. Fetal Diagn Ther. 2015;38(2):142–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-6751021","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":469947985,"identity":"bc5af626-1b5a-42d1-81eb-9d4854fe012c","order_by":0,"name":"Qi Li","email":"","orcid":"","institution":"Department of Ultrasound,Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Li","suffix":""},{"id":469947986,"identity":"d0aea81c-16de-4616-9257-ff66068e3ee8","order_by":1,"name":"Yang Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Shandong First Medical University \u0026 Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Abdominal Medical Ultrasound","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Li","suffix":""},{"id":469947987,"identity":"497fcb8f-ec53-4e6b-b31b-38ea81a554b1","order_by":2,"name":"Jingwei Liu","email":"","orcid":"","institution":"Department of Pediatric Surgery,Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Jingwei","middleName":"","lastName":"Liu","suffix":""},{"id":469947988,"identity":"45d39537-458e-407d-afac-f5ed3d3094a8","order_by":3,"name":"Haifang Wu","email":"","orcid":"","institution":"Department of Ultrasound,Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Haifang","middleName":"","lastName":"Wu","suffix":""},{"id":469947989,"identity":"e94c89bc-cb33-4aa5-a0ab-17a14cb157be","order_by":4,"name":"Yongqi Li","email":"","orcid":"","institution":"London School of Economics and Political Science","correspondingAuthor":false,"prefix":"","firstName":"Yongqi","middleName":"","lastName":"Li","suffix":""},{"id":469947990,"identity":"b43dcdf6-0204-459a-92b0-59591549c381","order_by":5,"name":"Guowei Tao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYDADNvbGhgMfKiTk5Amp5IFr4Tl88OGMMxbGhg3EamGQSEs25myrSGQ4QECLPfvhw695Kg7L8THkmEkzzpNIYGxgfvjoBj5beNLSrHnOHDZmYzhjJl24TSKPnYHN2DgHr8NyzIx5224ntjH2mEnP3CZRzNjAwyaNVwv/G7CW+jZmHjNp3jkSiQ0HCGmRyDF+DNSSwMbGlmzM20CMlhvP0hjnnPlv2MbDDAzkYxLGhs0E/MLen3z4w5uKNHn5+Q+BUVlTJyfP3vzwMT4tQMAmgcpnxq8crOQDYTWjYBSMglEwogEAD5hIb4MH7qgAAAAASUVORK5CYII=","orcid":"","institution":"Department of Ultrasound,Qilu Hospital of Shandong University","correspondingAuthor":true,"prefix":"","firstName":"Guowei","middleName":"","lastName":"Tao","suffix":""}],"badges":[],"createdAt":"2025-05-26 12:53:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6751021/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6751021/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84696311,"identity":"889ed2f4-de07-48b4-b71f-1253a52c482e","added_by":"auto","created_at":"2025-06-16 10:39:04","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":6714084,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound Findings of Bowel Dilation. (a) Diffuse bowel dilation: showing diffuse bowel dilation with a honeycomb-like appearance, occupying two-thirds of the abdomen. (b) Segmental bowel dilation: revealing focal bowel dilation in a smaller area, less than one-third of the abdomen. (c) Measurement method: illustrating the measurement of the widest diameter of bowel dilation, taken between the inner walls of the bowel. (d) Bowel echogenic enhancement: showing increased brightness in the fetal intestines, as indicated by the yellow arrow, equal to or greater than the iliac wings.\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6751021/v1/c6340020760698d200dfef96.jpg"},{"id":84697017,"identity":"32cd4ed4-9c3a-4db6-a598-592556020f3b","added_by":"auto","created_at":"2025-06-16 10:47:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":448392,"visible":true,"origin":"","legend":"\u003cp\u003eThe flowchart of this study. JIA,jejunoileal atresias.\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-6751021/v1/115f27cc9c1780edc5a227e7.png"},{"id":84696302,"identity":"e16e33fc-64c9-4f82-930d-a767bb8c14b6","added_by":"auto","created_at":"2025-06-16 10:39:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":81477,"visible":true,"origin":"","legend":"\u003cp\u003eRidge Trace Diagram on Log Lambda\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-6751021/v1/5e1528f9d9bc95d76402de43.png"},{"id":84696314,"identity":"741a5aca-e396-4ef4-8ce1-7b58518ccb8b","added_by":"auto","created_at":"2025-06-16 10:39:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":369639,"visible":true,"origin":"","legend":"\u003cp\u003eMarginal Propensity on Bowel diameter\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-6751021/v1/038a40f8f364b5e3742c50e6.png"},{"id":84696265,"identity":"d09b9273-2f97-4cc1-9a75-d3f9d0d892d5","added_by":"auto","created_at":"2025-06-16 10:38:59","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":234502,"visible":true,"origin":"","legend":"\u003cp\u003eMarginal Propensity on Dilation type and Polyhydramnios\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-6751021/v1/e63af9a0d14431b4584e4077.png"},{"id":94639913,"identity":"13661d10-217d-40f8-8de8-8c454a7de6b6","added_by":"auto","created_at":"2025-10-29 07:41:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8663652,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6751021/v1/b823cda4-15a9-4858-ad82-7a56f02a9184.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDiffuse Bowel Dilation as a Novel Diagnostic Marker for Jejunoileal Atresias: A Machine Learning Approach Integrating Risk Factors\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eJejunoileal atresias (JIA), a congenital obstruction in the jejunum or ileum with an incidence ranging from 1.3 to 2.8 cases per 10,000 newborns\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, is distinct from duodenal atresias (DA) characterized by lumen cavitation obstruction and has a highly complex etiology. The primary cause is the rupture of corresponding branches of the mesenteric artery, which can be triggered by various factors including mechanical disruptions like intussusception, perforation, torsion, hernia, and vascular-related incidents such as thromboembolism\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Moreover, emerging research has indicated potential genetic contributions, with Gupta et al. revealing a link between the expression of ITGA2 873 G/A and NPPA 2238 T/C nucleotide sequences and an increased JIA risk\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. This intricate web of potential causes highlights the need for comprehensive research on JIA to better understand its origin and develop more effective diagnostic and treatment strategies.\u003c/p\u003e \u003cp\u003eThe timing of surgical intervention for patients with JIA is crucial for determining their mortality and prognosis. Timely surgery is essential. Delaying the operation can lead to a series of severe consequences, including short bowel syndrome, small intestine necrosis, and dependence on total parenteral nutrition\u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Despite its crucial significance, the prenatal diagnosis of JIA remains a challenging task.\u003c/p\u003e \u003cp\u003eCompared to DA, the diagnosis of JIA is generally more challenging, despite both being intestinal atresias. DA is easier to diagnose prenatally, mainly due to distinct features like the 'double bubble sign' and polyhydramnios.In contrast, JIA is more difficult to identify prenatally. It seldom causes significant amniotic fluid volume changes, and the distal location of the intestinal obstruction complicates ultrasound diagnosis. Prenatal ultrasound findings related to JIA, such as intestinal dilation, enhanced intestinal echogenicity, and polyhydramnios, lack specificity as they can also be seen in other congenital gastrointestinal obstructions, including anal atresias, meconium ileus, midgut torsion or malrotation, intestinal duplication, and congenital megacolon\u003csup\u003e\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Overall, the overlapping features of JIA with other diseases make its prenatal diagnosis extremely difficult, underscoring the urgent need for more specific diagnostic methods.\u003c/p\u003e \u003cp\u003eIn our clinical work, we have observed that for fetuses with JIA, besides the ultrasonographic indicators such as bowel dilation, increased bowel echogenicity, and polyhydramnios, the morphological characteristics of bowel dilation may also be helpful in diagnosing JIA. Therefore, our research aim was to analyze the clinical and ultrasonographic features associated with JIA among fetuses with bowel dilation, providing valuable information for screening and treatment decision-making in high-risk populations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and Participants\u003c/h2\u003e \u003cp\u003eThis retrospective study of fetuses with dilated intestines, excluding those with suspected duodenal obstruction, loss of follow-up, induced labor, and other extraintestinal abnormalities. The study focused on fetuses with dilated intestines identified during routine prenatal ultrasound scans and other hospital referrals between From January 1, 2018, to November 15, 2024. The diagnostic gold standard for JIA was postpartum surgery and pathological results, categorizing fetuses with intestinal dilation into normal and suspected JIA based on postnatal diagnostic outcomes. The study used Philips IU22 and EPIQ7 instruments equipped with 3\u0026thinsp;~\u0026thinsp;5 MHz transducers. Ethical approval for this study was obtained from the ethics committee (No.KYLL-202410-025). Informed consent was obtained from all participants. Identifying data has been removed. All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical and Ultrasound Variables\u003c/h3\u003e\n\u003cp\u003eDemographic data included maternal age, maternal body mass index (BMI), infant gender, gestational age (GA) and weight at birth, as well as the GA diagnosed on the first and last ultrasound examination. The ultrasound data to be recorded included the type of bowel dilation, the widest diameter of dilation, enhanced intestinal echo, abdominal calcification, ascites, amniotic fluid volume assessment, and the presence of other intestinal-related abnormalities. Additionally, the weekly rate of bowel dilation was calculated.\u003c/p\u003e \u003cp\u003eIn our study, fetal bowel dilation was defined as a dilation of the bowel length of at least 15mm and/or a diameter of at least 7mm\u003csup\u003e\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. The classification of bowel dilation was divided into segmental and diffuse types, based on the distinct morphologies observed in ultrasound images. Diffuse bowel dilation was characterized by a honeycomb-like appearance, occupying approximately two-thirds of the abdomen. In contrast, segmental bowel dilation referred to a smaller area of dilation, accounting for less than one-third of the total abdomen. The morphology of bowel dilation may vary with increasing gestational age, and in such instances, the type of bowel dilation observed during the final ultrasound examination was taken into consideration. The measurement of the widest diameter of bowel dilation was determined as the distance between the inner walls of the bowel, excluding the bowel wall itself. Bowel echogenic enhancement was identified by increased brightness in the fetal intestines, with brightness equal to or greater than that of the iliac wings\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. The ultrasound characteristics mentioned above were illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The calculation of the bowel dilation rate involved determining the difference in bowel diameter measurements between two consecutive examinations and dividing this by the corresponding increase in gestational weeks.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe interpretation of ultrasound reports should be independently reviewed by two ultrasound physicians (Q.L.and H.F.W.) with more than five years of experience. In case of any objections to the results, a physician (G.W.T.) with more than ten years\u0026rsquo; experience would make the final determination. The process of obtaining case data involved a team of two researchers (Y.L. and J.W.L.) who worked together to retrieve, organize, and verify the data to ensure its reliability, completeness, and accuracy.\u003c/p\u003e\n\u003ch3\u003eFollow up\u003c/h3\u003e\n\u003cp\u003eAll fetuses were followed up until one month after birth. For live births, a postpartum assessment was conducted, and neonatal physical signs were recorded, including whether there was vomiting or bowel movement within the first 24 hours after birth, abdominal distension, and respiratory status, along with imaging examinations. If any of these results were abnormal, a consultation with a pediatric surgeon was considered to evaluate the possibility of JIA, and surgical treatment was performed with the consent of the patient's family.\u003c/p\u003e \u003cp\u003eThe gold standard for diagnosing JIA is direct intraoperative observation and postoperative pathological results. Jejunal atresias is defined as an obstruction occurring within 60cm of the ligament of Treitz; if the atresias is located more than 60 cm from the ligament of Treitz, it is classified as ileal atresias\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eModel development\u003c/h3\u003e\n\u003cp\u003eWe applied the lasso-logit model as our empirical research method to screen the final ultrasound variables and identify the features most closely associated with Jejunoileal atresias in model development. The loss function of the Lasso-Logit model took the following form:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\underset{\\beta\\:}{\\text{min}}\\:-\\sum\\:_{i=1}^{N}{y}_{i}\\:log\\left[{\\Lambda\\:}\\left({X}_{i}^{{\\prime\\:}}\\beta\\:\\right)\\right]+(1-{y}_{i})log\\left[1-{\\Lambda\\:}\\left({X}_{i}^{{\\prime\\:}}\\beta\\:\\right)\\right]+\\lambda\\:\\left|\\beta\\:\\right|$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhere \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\Lambda\\:}\\left(\u0026middot;\\right)\\)\u003c/span\u003e\u003c/span\u003e is the logistic link function; \u003cb\u003eX\u003c/b\u003e is the explanatory variable matrix, the elements of \u003cb\u003eX\u003c/b\u003e are \u0026lsquo;\u003cem\u003eDilation type\u003c/em\u003e\u0026rsquo;, \u0026lsquo;\u003cem\u003eIntestinal hyperechoic\u003c/em\u003e\u0026rsquo;, \u0026lsquo;\u003cem\u003eAbdominal calcification\u003c/em\u003e \u0026rsquo;, \u0026lsquo;\u003cem\u003eAscites\u003c/em\u003e\u0026rsquo;, \u0026lsquo;\u003cem\u003ePolyhydramnios\u003c/em\u003e\u0026rsquo;, \u0026lsquo;\u003cem\u003eAbdomen circumference\u003c/em\u003e \u0026rsquo;, \u0026lsquo;\u003cem\u003eBowel diameter\u003c/em\u003e\u0026rsquo;, \u0026lsquo;\u003cem\u003eDilated rate\u003c/em\u003e\u0026rsquo;; \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\mathbf{y}\\)\u003c/span\u003e\u003c/span\u003e is the binary dummy variable indicating whether the patient has jejunoileal atresias; \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\lambda\\:}\\left|{\\beta\\:}\\right|\\)\u003c/span\u003e\u003c/span\u003e is the penalty term.To determine the statistical significance of regression coefficients, we resample the original dataset by adapting bootstrap and implementing the percentile method to test the statistical significance of coefficients. Firstly, we conduct bootstrap resampling 1000 times to formulate the bootstrap density of coefficients. After that, we select the percentiles at the 1% significance level to construct the interval [\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\beta\\:}}_{0.5\\text{\\%}}^{\\ast\\:}\\:,\\:{{\\beta\\:}}_{99.5\\text{\\%}}^{\\ast\\:}\\)\u003c/span\u003e\u003c/span\u003e], in which the coefficient is statistically significant at the 1% level if 0 is not in the interval.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eTo assess data normality, we used the Quantile-Quantile plot (Q-Q plot). Normally distributed variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and were compared between two groups using \u003cem\u003et\u003c/em\u003e-tests. Non-normally distributed variables were reported as median and interquartile intervals (IQR) and analyzed with the Mann-Whitney U-test. Categorical variables were expressed as frequency and percentage, and tested using the Chi-square test or Fisher\u0026rsquo;s exact test. Statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. For missing data, we used regression imputation. Lasso-logit regression analysis was conducted in R version 4.4.1, with the \"glmnet\" package for statistical analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eFrom January 1, 2018, to November 15, 2024, a total of 323 fetuses with bowel dilation were included. Among them, 102 cases were excluded for suspected duodenal obstruction (based on the 'double bubble sign'), 30 for induced abortion, 24 for associated extraintestinal anomalies (e.g., cardiac or urinary malformations), and 90 for incomplete data or loss to follow-up. Among the 77 cases, 50 cases were diagnosed as normal newborns based on postnatal physical examinations and imaging results.\u003c/p\u003e \u003cp\u003eSurgical intervention was required for 27 cases, of which 23 were diagnosed with jejunoileal atresias through intraoperative and pathological findings. Specifically, cases included isolated jejunal atresias (n\u0026thinsp;=\u0026thinsp;7), jejunal atresias with other anomalies (n\u0026thinsp;=\u0026thinsp;5), isolated ileal atresias (n\u0026thinsp;=\u0026thinsp;6), ileal atresias with other anomalies (n\u0026thinsp;=\u0026thinsp;4), and combined jejunoileal atresias (n\u0026thinsp;=\u0026thinsp;1). Additionally, in the remaining 4 cases, intestinal dilation was found to be caused by other intestinal anomalies, including 1 case of intestinal duplication, 1 case of intestinal malrotation with midgut volvulus, and 2 cases of jejunum stenosis. Finally, our study included 50 normal and 23 JIA fetuses.The flowchart was shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBaseline characteristics of the 73 participants included maternal age (32.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86 years), BMI (27.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56 kg/m\u0026sup2;), gestational age at first ultrasound (31.82\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05 weeks),and the last (37.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84 weeks). In terms of pregnancy history, the median and interquartile range for the number of pregnancies and deliveries were (2.00 (1.75,3.00); 1.00 (0.00,1.00)), respectively. For the mode of delivery, the percentage of vaginal deliveries (50.68%,37/73) and cesarean deliveries (49.32%,36/73) were recorded. The gender distribution of the infants was (35.62%,26/73) boys and (64.38%,47/73) girls. For the Apgar scores of newborns, the median and IQR were all (10.00(10.00, 10.00)) at 1 minute, 5 minutes, and 10 minutes. The gestational age at birth was 38.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53 weeks, and the birth weight was 3188.62\u0026thinsp;\u0026plusmn;\u0026thinsp;398.50 g.\u003c/p\u003e \u003cp\u003eIn the univariate analysis, we classified 73 participants with bowel dilation into JIA and control groups based on the pathological gold standard. Statistical analysis revealed significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in clinical and ultrasound features, including gestational age at birth, Apgar scores, the pattern of bowel dilation, intestinal hyperechoic, ascites, polyhydramnios, intestinal diameter, and the rate of intestinal dilation, between the two groups, indicating a potential correlation with JIA (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and ultrasound findings of normal and jejunoileal atresias fetuses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJIA (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravidity (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.00 (1.00,3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.00 (1.70,4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00 (0.00,1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00 (0.00,1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (60.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (44.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal delivery (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (39.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (56.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA at delivery (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.023*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthweight (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3110.87\u0026thinsp;\u0026plusmn;\u0026thinsp;524.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3223.98\u0026thinsp;\u0026plusmn;\u0026thinsp;340.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.345\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (43.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (32.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (56.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (68.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApgar score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 minute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.00 (9.50,10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.00 (10.00,10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.00 (9.80,10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.00 (10.00,10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.00 (10.00,10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.00 (10.00,10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUltrasound Variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilation type(n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSegmental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (65.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiffuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (34.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal hyperechoic (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (34.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (16.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal calcification (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (8.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAscites (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (8.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (73.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAC (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e338.57\u0026thinsp;\u0026plusmn;\u0026thinsp;23.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e335.60\u0026thinsp;\u0026plusmn;\u0026thinsp;14.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowel diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.0 (24.0, 37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0 (14.0,18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilated rate (mm/week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.17 (1.40,3.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89 (0.50,1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eJIA,Jejunoileal atresias; BMI, body mass index; GA, gestational age; AC, abdomen circumference; *, significant differences.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eModel derivation\u003c/h3\u003e\n\u003cp\u003eThe independent variables were entered into the lasso-logit model to screen the final ultrasound variables. We employed ridge trace diagrams and cross-validation to determine the optimal lambda value. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the ridge trace plot, ranking variable importance from highest to lowest: dilation type, polyhydramnios, bowel diameter, intestinal hyperechogenicity, and dilation rate.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccording to Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the plot stabilizes at log(λ) = -4.814. Consequently, the optimal lambda suggested by the ridge trace was 0.00811. To ensure the robustness of the previous result, we employed cross-validation to identify the lambda value that minimized the loss.\u003c/p\u003e \u003cp\u003eBased on the results presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, dilation type, polyhydramnios, and bowel diameter are the primary explanatory variables in the lasso-logit model. The odds ratios for JIA associated with dilation type, polyhydramnios, and bowel diameter are 320.86, 108.85 and 55.09 respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLasso-Logit Regression Results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLower bound (10%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper bound (10%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilation type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.771*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e320.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.349\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal hyperechoic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.690*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal calcification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.982\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAscites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.755\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowel diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.009*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilated rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.726\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*,Dilation type, Polyhydramnios, and Bowel diameter are the primary explanatory variables in the lasso-logit model\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGiven that these odds ratios are greater than 1, dilation type, polyhydramnios, and bowel diameter exert a positive marginal effect on the risk of JIA. Since variables have been normalized, the value of coefficients is comparable. According to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, dilation type makes the most substantial contribution to explaining JIA, while polyhydramnios and bowel diameter carry similar weights in the model.\u003c/p\u003e \u003cp\u003eFigures \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e present the marginal propensity diagrams for dilation type, polyhydramnios, and bowel diameter, illustrating the relationship between the explanatory variables of interest and the probability of JIA, while holding all other variables constant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs shown in the Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, an increase in the normalized bowel diameter leads to a higher probability of JIA. Given a specific bowel diameter, the probability of JIA is highest when both diffuse dilation and polyhydramnios are present, followed by cases with only diffuse dilation. The lowest probability occurs in the absence of both polyhydramnios and diffuse dilation. The probability of JIA exceeds 50% when the normalized bowel diameter reaches 1.1 (corresponding to an actual diameter of approximately 34.4 mm).\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e illustrates the probability of JIA under different combinations of bowel dilation type and polyhydramnios. Isolated bowel dilation (Dilation type\u0026thinsp;=\u0026thinsp;1, Polyhydramnios\u0026thinsp;=\u0026thinsp;0) is associated with an 81.8% probability of JIA, indicating its role as a dominant independent risk factor, whereas isolated polyhydramnios (Dilation type\u0026thinsp;=\u0026thinsp;0, Polyhydramnios\u0026thinsp;=\u0026thinsp;1) shows a moderate probability of 60.4%.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eUltrasound Features and Prognosis of Jejunal Atresias versus Ileal Atresias\u003c/h2\u003e \u003cp\u003eAccording to the pathological results, jejunoileal atresias cases were divided into two groups: the jejunal atresias group and the ileal atresias group. No significant differences are found in polyhydramnios, associated abnormalities, or postoperative short bowel syndrome (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, diffuse dilation and postoperative meconium peritonitis are statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifferences between cases of jejunal and ileal atresia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJejunum atresia(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIleum atresia(n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrenatal ultrasound findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (83.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (60.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowel diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.5 (24.0, 40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.5 (23.75,38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilation type (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSegmental\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (91.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (30.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDiffuse\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (70.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal hyperechoic (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal calcification (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAscites (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilated rate (mm/week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.17 (1.46,3.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.98 (-0.63,3.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative condition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eother intestinal abnormalities(n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (41.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMidgut malrotation\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCongenital intestinal stenosis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSmall intestine volvulus\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeconium peritonitis (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShort bowel syndrome (n,%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA at delivery (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthweight (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2800 (2600,3575)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3175 (2978,3525)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eGA, gestational age; *,significant differences\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study identified diffuse bowel dilation, polyhydramnios, and larger bowel diameters as key prenatal predictors of JIA in fetuses with bowel dilation. The Lasso - logit model showed that fetuses presenting with diffuse bowel dilation, increased amniotic fluid, and wider bowel diameters were at a higher risk of atresias. Specifically, diffuse bowel dilation was a particularly strong predictor.\u003c/p\u003e \u003cp\u003eThe identification of diffuse bowel dilation as the strongest predictor of JIA, with an exceptionally high odds ratio of 320.86 in the Lasso-Logit model, represented a significant advancement in prenatal diagnostics. This finding suggested that fetuses exhibiting diffuse intestinal dilation had over 300 times higher odds of developing JIA compared to those without this feature, even after adjusting for confounders such as polyhydramnios and bowel diameter. The associated probability of 81.8% for JIA in cases of isolated diffuse dilation further underscored its clinical relevance as a standalone diagnostic marker.Previous studies on prenatal JIA diagnosis focused on indirect markers such as polyhydramnios, hyperechogenicity, or bowel diameter thresholds\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. However, these indicators lack specificity and are often confounded by other fetal anomalies (e.g., esophageal atresia or chromosomal disorders). To our knowledge, no prior studies have explicitly proposed diffuse intestinal dilation as an independent diagnostic criterion for JIA. This novel marker addressed a critical gap by directly linking morphological severity (diffuse vs. segmental dilation) to the likelihood of atresia, thereby enhancing diagnostic precision.\u003c/p\u003e \u003cp\u003eThis study observed that jejunal atresias predominantly manifested as segmental dilation, whereas ileal atresias were characterized by diffuse dilation, potentially reflecting embryological and functional distinctions. Jejunal segmental dilation may arise from localized vascular disruptions or compensatory mechanisms in its wider lumen, while ileal diffuse dilation could result from impaired recanalization or pressure buildup in narrower, meconium-rich segments. Structural differences in intestinal walls (e.g., thinner ileal musculature) may further predispose to diffuse patterns. However, these findings were limited by a small sample size on prenatal ultrasound, necessitating cautious interpretation. Future validation in larger cohorts, combined with fetal MRI or histopathological correlation, is critical to confirm these patterns and elucidate underlying mechanisms.\u003c/p\u003e \u003cp\u003ePrevious literature has reported the use of intestinal diameter measurements as a tool to differentiate between normal fetuses and those with jejunoileal atresias\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. We observed that fetuses with jejunoileal atresias exhibited larger bowel diameters compared to normal fetuses (32mm vs. 16mm). As the lumen increases, the probability of disease also increases. When the diameter of the luminal diameter is greater than 34.4mm, the probability of disease will be greater than 50%. Bowel diameter can serve as a potential ultrasound indicator for distinguishing normal fetuses from those with jejunoileal atresias, as intestinal obstruction can lead to increased intestinal pressure, resulting in proximal intestinal dilation at the site of obstruction. In contrast, normal fetuses typically maintain a smaller intestinal diameter and do not exhibit significant pressure induced dilation.\u003c/p\u003e \u003cp\u003eUnivariate analysis showed that fetuses with JIA exhibited a significantly higher weekly bowel dilation rate compared to normal fetuses (2.17mm vs. 0.89mm; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a statistically significant association between dilation rate and JIA. These findings were consistent with prior studies by Rapha\u0026euml;le Mangione et al., which also emphasized dilation rate as a diagnostic indicator for JIA.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e However, in the multivariate logistic regression model, this association was attenuated and lost statistical significance after adjusting for confounders such as dilation type, polyhydramnios, and bowel diameter, suggesting that dilation rate may indirectly reflect obstruction severity through its correlation with static morphological markers (e.g., bowel diameter) rather than acting as an independent predictor.\u003c/p\u003e \u003cp\u003eNotably, intestinal lumen widening and accelerated growth rates were not universally observed in all obstructed fetuses. In two exceptional cases, decreased intestinal lumen diameter and negative growth rates were detected during late pregnancy. This phenomenon was attributed to perinatal intestinal rupture caused by excessive dilation, which allowed intestinal contents to leak into the abdominal cavity. The subsequent reduction in intraluminal pressure led to lumen contraction and reversed growth patterns. These cases highlighted the complexity of JIA pathophysiology, where extreme dilation may trigger structural failure, altering typical disease progression.\u003c/p\u003e \u003cp\u003eThe identification of diffuse bowel dilation as a powerful diagnostic marker for JIA has significant clinical implications. It can potentially enable earlier and more accurate prenatal diagnosis, allowing for better prenatal counseling and more timely postnatal surgical intervention. This may improve the prognosis for affected neonates by reducing the risk of complications such as short bowel syndrome and small intestine necrosis. However, before this information can be confidently used in clinical settings, additional research with larger sample sizes is required to validate these findings and establish more precise diagnostic algorithms.\u003c/p\u003e \u003cp\u003eThere are still unanswered questions. For example, the underlying mechanisms of why jejunal atresias predominantly show segmental dilation while ileal atresias show diffuse dilation need further exploration. Future research could also focus on validating these findings in larger, multicenter cohorts and integrating other imaging modalities like fetal MRI for more comprehensive diagnosis. Additionally, studies could investigate the combined effects of genetic factors and these ultrasound markers on JIA development.\u003c/p\u003e \u003cp\u003eOne of the strengths of this study is its use of a well - defined retrospective cohort and a rigorous statistical model (Lasso - logit model) to identify relevant predictors. The clear definition of ultrasound variables and the use of experienced reviewers for ultrasound reports also add to the reliability of the data collection. However, the study has limitations. The relatively small sample size of JIA cases may lead to insufficient statistical power, potentially affecting the generalizability of the results. There is also a risk of observer bias during the image review process, which could impact the consistency of diagnostic assessments.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study established diffuse bowel dilation as a groundbreaking diagnostic marker for jejunoileal atresias, demonstrating unparalleled predictive power in prenatal ultrasound. The integration of bowel diameter thresholds and polyhydramnios further refines risk stratification, enabling earlier and more accurate diagnosis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eJIA,jejunoileal atresias\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDA,duodenal atresias\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Qilu Hospital, Shandong University (No.KYLL-202410-025). Informed consent was obtained from all participants.Identifying data has been removed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQi Li\u003c/strong\u003e: Conceptualization, Methodology, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eYang Li\u003c/strong\u003e: Conceptualization, Formal analysis, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eGuowei Tao\u003c/strong\u003e: Conceptualization, Methodology, Project administration. \u003cstrong\u003eJingwei Liu\u003c/strong\u003e: Data curation, Resources.\u003cstrong\u003eHaifang Wu\u003c/strong\u003e: Data curation, Resources. \u003cstrong\u003eYongqi Li\u003c/strong\u003e: Formal analysis, Validation.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported by Natural Science Foundation of Shandong Province, ZR2022QH381\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRubio EI, Blask AR, Badillo AT, Bulas DI. Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes. Pediatr Radiol. 2017;47(4):411\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDidier-Mathon H, Gr\u0026eacute;vent D, Khen-Dunlop N, Sonigo P, Rousseau V, Ville Y, Boddaert N, Kermorvant E, Mahallati H, Salomon LJ, Millischer A\u0026Eacute;. Ultrasound and Fetal MRI Complementary Contributions to Appropriate Counseling in Small Bowel Obstruction. Fetal Diagn Ther. 2021;48(8):567\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLupo PJ, Isenburg JL, Salemi JL, Mai CT, Liberman RF, Canfield MA, Copeland G, Haight S, Harpavat S, Hoyt AT, Moore CA, Nembhard WN, Nguyen HN, Rutkowski RE, Steele A, Alverson CJ, Stallings EB, Kirby RS, The National Birth Defects Prevention Network. Population-based birth defects data in the United States, 2010\u0026ndash;2014: A focus on gastrointestinal defects. Birth Defects Res. 2017;109(18):1504\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakahashi D, Hiroma T, Takamizawa S, Nakamura T. Population-based study of esophageal and small intestinal atresias/stenosis. Pediatr Int. 2014;56(6):838\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatterson KN, Cruz S, Nwomeh BC, Diefenbach KA. Congenital duodenal obstruction - Advances in diagnosis, surgical management, and associated controversies. Semin Pediatr Surg. 2022;31(1):151140.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStollman TH, de Blaauw I, Wijnen MH, van der Staak FH, Rieu PN, Draaisma JM, Wijnen RM. Decreased mortality but increased morbidity in neonates with jejunoileal atresias; a study of 114 cases over a 34-year period. J Pediatr Surg. 2009;44(1):217\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaestro Dur\u0026aacute;n MA, Costas Mora M, Camino Caballero F. Small-bowel atresias: a case series with review of the disease and imaging findings. Radiologia (Engl Ed). 2022;64(2):156\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaalabian K, Friedmacher F, Theilen TM, Keese D, Rolle U, Gfroerer S. Prenatal Detection of Congenital Duodenal Obstruction-Impact on Postnatal Care. Child (Basel). 2022;9(2):160.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBishop JC, McCormick B, Johnson CT, Miller J, Jelin E, Blakemore K, Jelin AC. The Double Bubble Sign: Duodenal Atresias and Associated Genetic Etiologies. Fetal Diagn Ther. 2020;47(2):98\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta T, Yang W, Iovannisci DM, Carmichael SL, Stevenson DK, Shaw GM, Lammer EJ. Considering the vascular hypothesis for the pathogenesis of small intestinal atresias: a case control study of genetic factors. Am J Med Genet A. 2013;161A(4):702\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR\u0026oslash;kkum H, Johannessen H, Bj\u0026oslash;rnland K. Perioperative and Long-Term Outcome in Patients Treated for Jejunoileal Atresias. J Pediatr Gastroenterol Nutr. 2023;76(4):434\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang T, Feng H, Cao Y, Tao Y, Lu L, Yan W, Li F, Wang Y, Cai W. Long-term outcomes of various pediatric short bowel syndrome in China. Pediatr Surg Int. 2021;37(4):495\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMutanen A, Engstrand Lilja H, Wester T, Norrby H, Borg H, Persson S, Bjornland K, Brun AC, Telborn L, Stenstr\u0026ouml;m P, Pakarinen MP. A nordic multicenter study on contemporary outcomes of pediatric short bowel syndrome in 208 patients. Clin Nutr. 2023;42(7):1095\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Jobeer H, Al Dossari M, Babic I. Association between fetal echogenic and/or dilated bowel and adverse perinatal outcomes. Pediatr Int. 2023;65(1):e15496.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWax JR, Hamilton T, Cartin A, Dudley J, Pinette MG, Blackstone J. Congenital jejunal and ileal atresias: natural prenatal sonographic history and association with neonatal outcome. J Ultrasound Med. 2006;25(3):337\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen D, Tam KH, Xiao Y, Geng J, Tan Y, Zhu X, Ge W, Zhou J, Xiao S, Chen J. New sonographic feature (C-sign) to improve the prenatal accuracy of jejunal atresias. J Obstet Gynaecol Res. 2021;47(12):4196\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVena F, Mazza A, Bartolone M, Vasta A, D'Alberti E, Di Mascio D, D'Ambrosio V, Volpe G, Signore F, Pizzuti A, Giancotti A. Hyperechogenic fetal bowel: Current evidence-based prenatal diagnosis and management. J Clin Ultrasound. 2023;51(7):1172\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaddock M, Beattie G, Froste D, Offiah AC, Nicholl R. Should postnatal ultrasound be performed when isolated echogenic bowel has been reported on the antenatal ultrasound. Arch Dis Child. 2020;105(1):98\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi X, Zhou M, Wang S, Zhang C. The role of multimodal ultrasound in diagnosis of fetal bowel dilation and prediction of adverse neonatal outcomes: A study of 86 cases in a series of 43,562 births. Heliyon. 2024;10(5):e27455.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLap CC, Voskuilen CS, Pistorius LR, Mulder E, Visser G, Manten G. Reference curves for the normal fetal small bowel and colon diameters; their usefulness in fetuses with suspected dilated bowel. J Matern Fetal Neonatal Med. 2020;33(4):633\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMangione R, Voirin-Mathieu E, Yvert M, Fries N, Mousty E, Castaigne V, Muller F, Dreux S, DILDIG Study Group. Fetal intestinal loop dilation: Follow-up and outcome of a series of 133 consecutive cases (the DILDIG study). Prenat Diagn. 2023;43(3):328\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaird A, Shekleton P, Nataraja RM, Kimber C, Pacilli M. Incidence of gastro-intestinal anomalies and surgical outcome of fetuses diagnosed with echogenic bowel and bowel dilation. Prenat Diagn. 2019;39(12):1115\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTongsin A, Anuntkosol M, Niramis R. Atresias of the jejunum and ileum: what is the difference. J Med Assoc Thai. 2008;91(Suppl 3):S85\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVirgone C, D'antonio F, Khalil A, Jonh R, Manzoli L, Giuliani S. Accuracy of prenatal ultrasound in detecting jejunal and ileal atresia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;45(5):523\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva P, Reis F, Alves P, Farinha L, Gomes MS, C\u0026acirc;mara P. Fetal Bowel dilation: A Sonographic Sign of Uncertain Prognosis. \u003cem\u003eCase Rep Obstet Gynecol\u003c/em\u003e 2015; 2015:608787.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohn R, D'Antonio F, Khalil A, Bradley S, Giuliani S. Diagnostic Accuracy of Prenatal Ultrasound in Identifying Jejunal and Ileal Atresias. Fetal Diagn Ther. 2015;38(2):142\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"Diffuse bowel dilation, Jejunoileal atresias, Prenatal diagnosis, Ultrasound markers, Congenital obstruction","lastPublishedDoi":"10.21203/rs.3.rs-6751021/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6751021/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eJejunoileal atresias (JIA) are congenital intestinal obstructions with a complex etiology, where timely surgery is crucial but prenatal diagnosis is challenging due to overlapping ultrasound signs with other disorders. This study aimed to identify key prenatal ultrasound and clinical predictors of JIA in fetuses with bowel dilation, with a focus on novel morphological markers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe performed a retrospective analysis of cases from From January 1, 2018, to November 15, 2024, with fetal bowel dilation. Demographic information and ultrasound data were collected. The Lasso-logit model was employed to screen the final variables. Moreover, the marginal propensity diagrams were utilized to visually display the change in the probability of JIA occurrence with the variation of these variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDilation type, polyhydramnios, and bowel diameter were primary explanatory variables in the model, with odds ratios of 320.86, 108.85, and 55.09 respectively. JIA probability exceeds 50% when the normalized bowel diameter reaches 1.1 (about 34.4 mm actual diameter).With a specific bowel diameter, JIA probability is highest when both diffuse dilation and polyhydramnios exist, followed by only diffuse dilation, and lowest without both.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDiffuse bowel dilation, larger bowel diameter, and polyhydramnios are critical ultrasound markers for JIA. The proposed Lasso-Logit model highlights diffuse dilation as a novel, independent diagnostic criterion, addressing gaps in prenatal specificity.\u003c/p\u003e","manuscriptTitle":"Diffuse Bowel Dilation as a Novel Diagnostic Marker for Jejunoileal Atresias: A Machine Learning Approach Integrating Risk Factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-16 10:38:30","doi":"10.21203/rs.3.rs-6751021/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":"43b97075-793f-4f2c-82ba-f1c268dfaea3","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T03:51:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-16 10:38:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6751021","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6751021","identity":"rs-6751021","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}