Fetal Intestinal Dilatation and Digestive Tract Abnormalities: An Analysis of 94 Cases from 16,090 Deliveries in Eastern Tianjin

Fetal Intestinal Dilatation and Digestive Tract Abnormalities: An Analysis of 94 Cases from 16,090 Deliveries in Eastern Tianjin | 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 Fetal Intestinal Dilatation and Digestive Tract Abnormalities: An Analysis of 94 Cases from 16,090 Deliveries in Eastern Tianjin Shaohua Wang, xinying Zhou, Ruifang Chen, Bin Yang, Linxue Guan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7714564/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 Purpose This study aimed to investigate the association between structural abnormalities of the digestive system in newborns and prenatal ultrasound findings of fetal intestinal dilatation. Methods A retrospective analysis was conducted using clinical data from neonates with digestive tract abnormalities delivered at the Third Central Hospital of Tianjin between 1 January 2021 and 31 May 2025. Results A total of 27 neonates were diagnosed with structural abnormalities of the digestive tract. These included 17 cases of congenital anal stenosis, 2 cases of congenital anal atresia, 3 cases of congenital megacolon, 2 cases of intestinal atresia, 1 case of annular pancreas, 1 case of gastric duplication, and 1 case of duodenal web. Additionally, 67 cases were identified with functional digestive system disorders, comprising 3 cases of meconium plug syndrome and 6 cases of gastroesophageal reflux. The remaining cases, which lacked a clear aetiology, were successfully resolved following conservative medical management. No statistically significant difference was observed between the two groups in the rate of abnormal prenatal ultrasound findings or in the degree of intestinal dilatation. Furthermore, there were no significant differences in maternal age, parity, incidence of hypertension, diabetes, hypothyroidism, or in abnormalities related to amniotic fluid, umbilical cord, or placenta. Significant differences were identified in birth weight and birth length; however, no significant differences were found in head circumference, neutrophil count, lymphocyte count, haemoglobin level, platelet count, liver function tests, or calcium and phosphorus metabolism. Conclusion Structural abnormalities of the upper digestive tract in newborns may present earlier and be more readily detectable on prenatal ultrasound imaging. In contrast, structural abnormalities of the lower gastrointestinal tract may not exhibit clear anomalous features on prenatal ultrasound. Therefore, reliance solely on prenatal ultrasound examination for diagnostic investigation is not recommended. Clinicians should perform a timely differential diagnosis after birth based on clinical symptoms and signs to avoid delays in diagnosis and treatment. Fetus Intestinal dilatation Digestive system abnormalities Introduction With the continuous advancement of ultrasound technology, prenatal ultrasound screening for fetal developmental abnormalities, including those of the fetal intestines, has become increasingly accurate. Multiple studies have indicated that fetal intestinal dilatation may suggest a poor digestive system prognosis [1-2] . In clinical practice, it has been observed that some children with a history of fetal intestinal dilatation indeed exhibit abnormal development of the digestive system. However, it has also been noted that some newborns diagnosed with congenital structural abnormalities of the digestive system had no abnormal findings on prenatal ultrasound. Thus, there appears to be no clear consensus regarding whether prenatal ultrasound can reliably indicate structural abnormalities of the digestive system in newborns. To address this issue, this article reviews and analyses relevant cases from our hospital over a period of approximately five years. 1 Information and methods 1.1 The study cohort comprised a total of 94 cases, incorporating data from all patients presenting with prenatal fetal intestinal dilatation, structural abnormalities of the digestive system in the newborn, or functional digestive disorders of unclear aetiology, between 1 January 2021 and 31 May 2025. For cases involving functional disorders, perinatal factors such as preterm birth, low birth weight, small for gestational age, perinatal asphyxia, infection, and hypoglycaemia were excluded. The gestational ages ranged from 35⁺⁶ to 41⁺⁴ weeks, with a mean gestational age of 39⁺³ weeks. 1.2 The examinations were performed using GE (USA) Voluson E10 and Voluson E8 colour Doppler ultrasound diagnostic systems, equipped with two-dimensional convex array probes operating at a frequency of 2–5 MHz. 1.3 Research methods and diagnostic criteria The prenatal ultrasound examination primarily involved the measurement of fetal growth parameters and structural assessment, including but not limited to the location, internal diameter, and extent of any identified intestinal dilatation. The “double-bubble sign” was defined as the communication between the gastric bubble, located in the left upper abdomen, and the dilated proximal duodenum, situated in the right upper abdomen, via the pylorus [3] . The small intestine is typically located in the mid-abdomen, while the colon is positioned peripherally in the lower abdomen and exhibits haustral markings. A small intestinal diameter exceeding 7 mm or a colonic internal diameter greater than 18 mm was considered indicative of intestinal dilatation [4] . Polyhydramnios was diagnosed when the amniotic fluid index exceeded 250 mm. Umbilical cord abnormalities included cord entanglement (e.g., nuchal cord), torsion, prolapse, excessive length (>100 cm), short cord (<30 cm), and single umbilical artery. Placental abnormalities encompassed morphological anomalies (such as succenturiate placenta, membranous placenta, and annular placenta), abnormal implantation (including placenta praevia and placenta accreta), and functional disorders (such as placental insufficiency and placental abruption). 1.4 Normality of the measurement data was assessed using SPSS 26.0 software. Differences between the two groups were evaluated using the t-test for normally distributed data. For categorical data, differences between groups were analysed by means of the chi-square (χ²) test. A p -value of less than 0.05 was considered statistically significant. 2. Results 2.1 Between 1 January 2021 and 31 May 2025, there were 16,090 deliveries in our hospital. Among these, 27 neonates were diagnosed with structural abnormalities of the digestive tract. These cases included 17 instances of congenital anal stenosis, 2 of congenital anal atresia, 3 of congenital megacolon, 2 of intestinal atresia, and one case each of annular pancreas, gastric duplication, and duodenal web. Additionally, 67 cases presented with functional disorders of the digestive system, comprising 3 cases of meconium plug syndrome and 6 cases of gastroesophageal reflux. The remaining cases, for which no clear cause was identified, resolved following conservative medical management. Among the 27 cases with structural abnormalities of the digestive tract, 17 cases (63%) exhibited abnormal findings on prenatal intestinal ultrasound. These included one case each of gastric duplication, duodenal web, and annular pancreas (demonstrating a double-bubble sign), all of which involved the upper digestive tract and were clearly identified during prenatal screening. These anomalies were detected between 24 and 36 weeks of gestation and were subsequently confirmed by postnatal surgery. The remaining cases presented with intestinal dilatation, measuring between 1.4 cm and 2.3 cm in width, and were identified at gestational ages ranging from 35⁺¹ to 40⁺⁶ weeks. Among the 10 cases with no abnormal prenatal ultrasound findings, six were diagnosed postnatally with congenital anal stenosis, two with congenital megacolon, one with congenital anal atresia, and one with intestinal obstruction, all representing structural abnormalities of the lower digestive tract. Prenatal ultrasound detected abnormalities in 51 of the 67 cases (76%) with functional digestive disorders. All presented with fetal intestinal dilatation, measuring between 1.5 cm and 2.8 cm in width, which was identified at gestational ages ranging from 33⁺² to 40⁺⁶ weeks. During the study period, the annual proportion of digestive system abnormalities detected by prenatal ultrasound relative to the number of deliveries was 0.04% (2/4125) in 2021, 0.1% (5/4816) in 2022, 0.1% (4/3256) in 2023, 0.5% (20/3481) in 2024, and 2% (35/1700) between January and May 2025, demonstrating a marked year-on-year increase. 2.2 There was no statistical significance in comparison between structural problems and functional problems in newborn digestive system(Table 1). The mean values of the abnormal expansion of the intestinal tube were 1.76+265 cm and 1.88+240 cm respectively, and there was no statistical significance ( F = 0.266, t = 1.539, P = 0.129) between the two groups. Table 1. Comparison of prenatal ultrasound detection rates between neonates with structural and functional digestive tract abnormalities Group Antenatal intestinal abnormalities detected, n No antenatal intestinal abnormalities detected, n Structured problem 17 10 functional problem 51 15 Z -1.447 P 0.148 2.3 Maternal age, hypertension, diabetes, hypothyroidism, and the rate of non-Lactococcus colonisation showed no significant differences between the two groups of mothers of neonates with structural or functional digestive system abnormalities(Table 2). Similarly, no significant differences were observed between the two groups in infant gender, amniotic fluid volume, umbilical cord abnormalities, placental abnormalities, birth order, or head circumference(Table 3). However, significant differences were identified in birth weight and birth length(Table 3), but not in neutrophil count, lymphocyte count, haemoglobin level, platelet count, liver function, and calcium and phosphorus metabolism(Table 4). Table 2. Comparison of perinatal characteristics and infant sex between neonates with structural and functional digestive tract abnormalities Characteristic Structural abnormalities group (n = 27) Functional disorders group (n = 67) Z P Maternal factors Hypertension, n 6 3 -0.757 0.449 Diabetes, n 7 14 -0.503 0.615 Hypothyroidism, n 2 13 -0.978 0.328 Non- Lactococcus colonisation, n 4 5 -1.583 0.113 Perinatal factors Amniotic fluid abnormality, n 3 3 -0.17 0.865 Umbilical cord abnormalities, n 9 27 -0.202 0.84 Placental abnormalities, n 2 9 -0.414 0.679 Gender Male, n 11 32 -0.466 0.642 Table 3. Comparison of maternal and neonatal characteristics between structural and functional digestive tract abnormality groups Characteristic Structural abnormalities group (n = 27) Functional disorders group (n = 67) F t P Maternal factors Maternal age (years) 29.81 ± 4.608 30.19 ± 3.577 1.777 0.427 0.67 Neonatal parameters Birth order 2.00 ± 1.519 1.72 ± 0.978 1.121 -1.073 0.286 Head circumference (cm) 33.84 ± 1.649 33.89 ± 1.148 4.564 0.146 0.884 Birth length (cm) 49.33 ± 2.675 50.63 ± 1.782 3.427 2.736 0.007 Birth weight (kg) 3.091 ± 0.489 3.411 ± 0.434 0.113 3.119 0.002 Table 4. Comparison of postnatal biochemical and haematological parameters between neonates with structural and functional digestive tract abnormalities Parameter Structural abnormalities group (n = 27) Functional disorders group (n = 67) F t P Haematological parameters Neutrophils (×10⁹/L) 11.318 ± 5.350 13.524 ± 5.249 0.003 1.83 0.071 Lymphocytes (×10⁹/L) 3.658 ± 1.105 4.091 ± 1.012 0.266 1.827 0.071 173.590 ± 22.077 174.130 ± 18.430 1.285 0.122 0.903 Platelets (PLT, ×10⁹/L) 253.440 ± 65.694 269.660 ± 50.400 0.985 1.29 0.2 Biochemical parameters Albumin (ALB, g/L) 37.415 ± 3.562 37.886 ± 2.964 1.825 0.656 0.514 ALT (U/L) 10.220 ± 4.462 11.647 ± 5.678 0.098 1.14 0.257 GGT (U/L) 182.540 ± 126.321 145.530 ± 99.713 1.723 -1.487 0.142 Total bile acids (TBA, μmol/L) 5.988 ± 3.013 5.468 ± 3.785 0.416 -0.625 0.534 Calcium (Ca, mmol/L) 2.335 ± 0.161 2.370 ± 0.146 0.946 1.06 0.292 Phosphorus (P, mmol/L) 1.700 ± 0.274 1.623 ± 0.267 0.243 -1.732 0.087 Magnesium (Mg, mmol/L) 0.806 ± 0.076 0.773 ± 0.065 1.473 -2.049 0.062 Abbreviations: HGB, haemoglobin; PLT, platelets; ALB, albumin; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase; TBA, total bile acids; Ca, calcium; P, phosphorus; Mg, magnesium. 3. Discussion The aetiology of fetal intestinal dilatation [5] can be broadly categorised as functional or structural, with an approximate incidence ratio of 1:1. Functional causes most commonly include meconium plug syndrome and meconium ileus, whereas structural causes are frequently related to meconium peritonitis, congenital intestinal atresia, congenital megacolon, intestinal malrotation, gastrointestinal duplication, anorectal atresia or stenosis, and cystic fibrosis. Functional intestinal abnormalities often carry a favourable prognosis following medical management, whereas structural anomalies typically necessitate surgical intervention. A poor prognosis is more likely if the condition is not detected early and managed proactively. Ultrasonography offers considerable advantages in clinical practice due to its convenience and ongoing technical advancements. Consequently, it is widely employed in prenatal intestinal screening. It is therefore of significant clinical importance to understand the specificity and sensitivity of ultrasound in detecting structural abnormalities of the digestive system in newborns. This study reviewed cases of children with structural digestive tract abnormalities at our centre over a five-year period. Gastric duplication, duodenal web, and annular pancreas were all accurately identified by prenatal ultrasound, with findings consistent with surgical outcomes. All three conditions are upper gastrointestinal tract abnormalities and were detected at an earlier gestational age. Previous studies [6-7] have also reported that structural abnormalities of the upper gastrointestinal tract are more likely to demonstrate abnormal imaging features as early as 9-12 weeks of gestation. Annular pancreas tends to be detectable earlier than duodenal anomalies [2] , and both conditions exhibit high sensitivity and specificity on prenatal ultrasound. It is noteworthy that prenatal ultrasound often reveals obstruction or blockage of the proximal intestinal segment rather than the intrinsic structural mal-formation of the bowel itself. Precise localisation of the obstructed intestinal segment remains challenging [8] . Some studies [9] indicate that the site of small intestinal atresia occurs more frequently in the distal jejunum, and that the sensitivity and specificity of diagnosis are higher when fetal small intestinal dilatation reaches 11.5 cm. In the present study, annular pancreas was accurately diagnosed prenatally by ultrasound through identification of the "double bubble sign". Similarly, gastric duplication and duodenal web were clearly demonstrated by prenatal imaging, achieving an accuracy of 100%. Attention should also be given to the suggestive value of the "vortex sign" for intestinal malrotation complicated by intestinal obstruction [10] . This study also observed that more proximal obstruction sites tend to present earlier on ultrasound, while more distal obstructions are detected later. Consequently, when abnormal findings in the fetal upper gastrointestinal tract are identified during pregnancy, obstetricians should actively coordinate with neonatology and paediatric surgery departments to facilitate early perioperative planning. In this study, prenatal ultrasound findings of lower digestive tract structural abnormalities presented with intestinal dilatation; however, no statistically significant difference was observed in either the detection rate of prenatal intestinal dilatation or its magnitude when compared to cases with functional disorders. This finding contrasts with some studies suggesting that greater intestinal dilatation is associated with a higher likelihood of poor prognosis [11] . This discrepancy may be attributed to the timing of diagnosis: in the present study, intestinal dilatation was predominantly identified during the late stage of pregnancy, with most cases detected within two weeks prior to delivery. This indicates that in-testinal dilatation in late gestation is not necessarily indicative of a structural ab-normality. This observation aligns with other studies [12] which report that transient dilatation of the fetal small intestine or colon can represent a normal physiological variant. Furthermore, the late stage of pregnancy imposes limitations on the frequency of dynamic monitoring of the intestinal tract. In most instances, intestinal dilatation was only transiently observed shortly before delivery, indicating that the sensitivity and specificity of detecting fetal intestinal dilatation in late gestation for identifying structural abnormalities of the neonatal digestive system are limited. This study also revealed that cases of structural abnormalities which were not detected by prenatal ultrasound all involved lower digestive tract developmental anomalies, including congenital megacolon, anal atresia, and anal stenosis. This observation is consistent with findings from other studies [13] . It is suggested that structural abnormalities of the lower digestive tract in newborns are prone to being overlooked during prenatal ultrasound examination. Careful attention should be given to excluding the presence of "target signs" and "funnel signs" [14-15] , and further evaluation should be conducted using two-dimensional ultrasound [16] . Concurrently, clinicians should perform detailed physical examinations, maintain close clinical observation, and undertake necessary postnatal imaging studies to accurately assess the newborn’s condition. The observed intestinal dilatation in late pregnancy, associated with functional disorders of the neonatal digestive system, is related to the developmental characteristics of the fetal intestinal tract. The fetal intestine undergoes continuous development throughout gestation, with its diameter gradually increasing as gestational age advances. The average diameter of the small intestine measures approximately 3 mm at 20–21 weeks and progressively increases to a maximum of 14 mm. Similarly, the diameter of the colon and rectum increases from 3–4 mm at 18–19 weeks to 8–15 mm by 20 weeks. The anal sphincter complex develops gradually during the fetal period, with anal maturation typically beginning around 22 weeks. Meconium formation starts at approximately 13 weeks and consists mainly of ingested amniotic fluid, necrotic epithelial cells, gastrointestinal gland secretions, and bile. During the mid to late stages of pregnancy, the fetal gastrointestinal tract begins to exhibit emptying and peristaltic movements, facilitating the gradual migration of meconium from the small intestine to the colon and rectum. Over time, the pressure exerted by the fetal anal sphincter increases. By around 20 weeks, a functional outlet obstruction may develop, leading to the accumulation of meconium within the intestines. The ingested amniotic fluid can be reabsorbed by the colon; however, as meconium continues to accumulate within the colon and rectum, the intestinal tract undergoes significant dilatation, thereby becoming detectable by ultrasound. In addition to structural abnormalities, numerous other factors, particularly in late pregnancy, can contribute to fetal intestinal dilatation. Functional factors such as meconium obstruction or transient intestinal ischaemia may lead to transient intestinal dilatation [17] . After birth, following spontaneous defecation or assisted evacuation of meconium, or upon restoration of blood supply, the obstruction resolves and the intestinal tract returns to its normal state. This observation is consistent with the findings of this study, in which many neonates with prenatal ultrasound evidence of intestinal dilatation exhibited no abnormal clinical symptoms or signs after delivery and were able to achieve full enteral feeding promptly following defecation. Therefore, the findings of this study highlight to clinicians that even a small degree of intestinal dilatation in late pregnancy may indicate a structural abnormality, while more pronounced dilatation could be associated with a functional disorder. It is not feasible to rely solely on the magnitude of intestinal dilatation to predict the nature of the underlying condition. Consequently, clinicians should maintain a high level of vigilance when managing such cases. A careful differential diagnosis should be performed to promptly identify structural abnormalities, enabling timely surgical intervention and reducing the risk of adverse prognostic outcomes. To improve the accuracy of prenatal diagnosis, serial ultrasound examinations at intervals of two to four weeks may be performed for cases with abnormal prenatal intestinal findings. Dynamic monitoring of intestinal width is recommended; progressive dilatation carries greater clinical significance [18] . Additional sonographic soft markers, such as anechoic areas, enhanced echogenicity, or polyhydramnios, may also be incorporated into the diagnostic evaluation. In cases where intestinal dilatation is detected early, the ratio of intestinal width to gestational age can be calculated; a lower value may be of greater clinical relevance. If multiple ultrasound indicators are abnormal, further investigation with magnetic resonance imaging (MRI) may be warranted. MRI can delineate the extent and location of intestinal dilatation and provide characteristic signal patterns on T1-weighted and T2-weighted sequences, which may offer clues regarding the site and nature of the abnormality [19-22] . For cases with high suspicion of intestinal developmental anomalies, prenatal whole-exome sequencing may be considered to assist in diagnosis [23] . In this study, neonates with structural abnormalities exhibited significantly lower postnatal weight and length compared to those with functional disorders, although both parameters remained within the normal range. To date, there are no published research data directly addressing this observation. Given that malformations of the digestive system may potentially affect fetal growth, vigilance is advised regarding the possibility of digestive tract abnormalities in neonates presenting with lower birth weight. No statistically significant differences were observed between the two groups in the incidence of common pregnancy complications or abnormalities of the umbilical cord and placenta, suggesting that these maternal factors have no predictive value for structural anomalies of the neonatal digestive system. Similarly, postnatal blood investigations showed no significant differences between the groups, indicating that structural abnormalities did not compromise the stability of the intrauterine environment. In summary, structural abnormalities of the upper gastrointestinal tract in newborns may be detected earlier and present more distinctly on prenatal ultrasound. Once identified, prompt postnatal assessment and diagnostic intervention are required. In contrast, structural anomalies of the lower digestive tract cannot be reliably diagnosed by prenatal ultrasound alone. Following delivery, paediatricians should undertake a timely differential diagnosis based on clinical symptoms, physical signs, and postnatal imaging studies to prevent delays in diagnosis and treatment. Abbreviations HGB, haemoglobin; PLT, platelets; ALB, albumin; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase TBA, total bile acids; Ca, calcium P, phosphorus; Mg, magnesium. Declarations Ethics declarations Ethics approval This study was conducted in accordance with the Declaration of Helsinki. All research methods were carried out in accordance with the relevant guidelines and regulations. The parents or legal guardians of all participants were informed consent to participate in this study. This study was approved by the Medical Research Ethics Professional Committee of the Third Central Hospital of Tianjin. Consent for publication Not applicable. Data availability The data that support the findings of this study are available from Corresponding author, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available upon reasonable request and with permission of Medical Research Ethics Professional Committee of the Third Central Hospital of Tianjin. Competing interests The authors declare no competing interests. Funding This work was supported by the Science and technology support project of Tianjin (21ZXGWSY00040). Author information Authors and Affiliations The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Centre, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China. Shaohua Wang, xinying Zhou, Ruifang Chen, Bin Yang, Linxue Guan, Wenxiao Wen, Shanshan Zhao. Corresponding author Correspondence to Xinying Zhou. Contributions Shaohua Wang wrote the manuscript text and prepared all figures.XinyingZhou supervised the manuscript. Ruifang Chen designed the study. Bing Yang provided secured funding .Linxue Guan,Wenxiao Wen and Shanshan Zhao assisted in data collection. All authors read and approved the final manuscript. Acknowledgements The authors would like to express their sincere gratitude to all the experts who helped them with this study. References Xuelei Li,Meng Zhou,Shanshan Wang, et al. The role of multimodal ultrasound in diagnosis of fetal bowel dilatation and prediction of adverse neonatal outcomes: A study of 86 cases in a series of 43,562 births[J].Heliyon,2024,10(5):e27455. doi: 10.1016/j.heliyon.2024.e27455. PMID: 38463772; PMCID: PMC10923836. Jiang Y, Wang W, Pan W, Wu W, Zhu D, Wang J. Study of Correlation between Fetal Bowel Dilation and Congenital Gastrointestinal Malformation. Children (Basel). 2024 May 31;11(6):670. doi: 10.3390/children11060670. PMID: 38929249; PMCID: PMC11201953. Yan Yingliu, Yang Xiuxiong. Prenatal ultrasound diagnosis [M]. 2nd edition. Beijing: People's Military Medical Press, 2012: 364-369. Eberhard M. ultrasound in Obstertrics and Gynecilogy,second edition,Geory Thieme Verlag,Stuttgart,Germany.2002:596. Corteville JE. Gray DL, Lanfer JC. Bowel abnormalities in the fetus-correlation of prenatal ultrasonographic findings with out-come[J] Am J Obstet Gynecol.1996,175:724-729. doi: 10.1053/ob.1996.v175.a74412. PMID: 8828441. Li X, Zhao Z, Li X, Zhao M, Kefei H. Appearance of fetal intestinal obstruction on fetal MRI. Prenat Diagn 2020; 40(11): 1398-1407. doi: 10.1002/pd.5779. Epub 2020 Aug 18. PMID: 32594545. Demirci O, Eriç Özdemir M, Kumru P, Celayir A. Clinical significance of prenatal double bubble sign on perinatal outcome and literature review[J]. J Matern Fetal Neonatal Med 2022; 35(10): 1841-7. doi: 10.1080/14767058.2021.1874338. Epub 2021 Jan 17. PMID: 33455511. Lv Z, Qu H, Hu J, Dong Y, Liu W. Analysis of Ileal Atresia from Prenatal Ultrasound to Postoperative Follow-up: Two Case Reports[J]. Curr Med Imaging. 2024;20:e15734056292576. doi: 10.2174/0115734056292576240426050921. PMID: 38693743. Gao Y, Ru Y, Han H, Yin H, Yin P, Gao Y. Prenatal Ultrasound Diagnosis and Clinical Analysis of Fetal Small Bowel Obstruction[J]. Curr Med Imaging. 2023 Nov 7. doi: 10.2174/0115734056262425231031171130. Epub ahead of print. PMID: 37957877. Yang L, Chen H, Lv G, Li F, Liao J, Ke L. Evaluation of ultrasonography in fetal intestinal malrotation with midgut volvulus[J]. Ginekol Pol. 2022;93(4):296-301. doi: 10.5603/GP.a2021.0237. Epub 2022 Feb 14. PMID: 35156693. Cao Hui, Deng Xuedong. Analysis of the correlation between fetal intestinal dilation and pregnancy outcomes [J].Chinese Journal of Medical Ultrasound (Electronic Edition), 2014, 11 (07): 46-49 Xiang Jinlian, Yan Yingliu, Kong Fanbin, etc. Prenatal ultrasound diagnosis and clinical outcome analysis of fetal intestinal dilation [J]. Tumor Imaging, 2021, 30(02): 114-118.DOI:10.19732/j.cnki.2096-6210.2021.02.010. A Syngelaki,R Mitsigiorgi,J Goadsby, et al. Routine 36-week scan: diagnosis of fetal abnormalities[J].Ultrasound Obstet Gynecol,2025,65(4):427-435. doi: 10.1002/uog.29218. Epub 2025 Mar 25. PMID: 40131231; PMCID: PMC11961102. Haiyan Kuang,Hui Cao,Sheng Wang, et al. New ultrasound features in diagnosing fetal anal atresia: a multicenter prospective cohort study [J].Sci Rep,2024,14(1):22821. Daglar HK, Kaymak D. Beyond the Target Sign: Two Cases of Low-Type Anal Atresia Diagnosed Prenatally With Fetal Perineal Imaging[J]. J Clin Ultrasound. 2025,53(7):1648-1652. doi: 10.1002/jcu.70008. Epub 2025 Jul 11. PMID: 40644566. T Elkan Miller,T Weissbach,M Elkan, et al. Infracoccygeal/transperineal window: new method to prenatally diagnose and classify level of anal atresia[J]. Ultrasound Obstet Gynecol,2024,64(4):521-527. doi: 10.1002/uog.29094. Epub 2024 Sep 1. PMID: 39219041. Ghi T,Tani G，CarlettiA，et al. Transient bowel ischaemia of the fetus[J]. Fetal Diagn Ther, 2005,20(1):54-7. doi: 10.1159/000081370. PMID: 15608461. Suting Xu,Wei Zhong,Zhuanxing Shen, et al. Analysis of the clinical outcomes of fetal bowel dilatation combined with other abnormal ultrasonographic features[J]. J Matern Fetal Neonatal Med,2019,32(6):992-996. doi: 10.1080/14767058.2017.1397123. Epub 2017 Nov 7. PMID: 29113511. Liu Sanchun, Li Xiao Hu, Yin Chuangao, et al. The value of MRI in the diagnosis of fetal digestive tract obstruction [J]. Journal of Clinical Radiology, 2022, 41: 923-927. Xia Yanyu, Yang Wenzhong, Lan Weishun, etc.The diagnostic value of MRI in fetal intestinal dilation [J]. Journal of Clinical Radiology, 2023, 42(09): 1493-1496. Zhang Zhengwei, Yin Qiufeng, Zhang Yuzhen, etc. MRI diagnosis and clinical outcome analysis of fetal intestinal dilation [J]. Journal of Clinical Radiology, 2022, 41(10): 1962-1967. Didier-Mathon H, Grévent D, Khen-Dunlop N, et al. Ultrasound and Fetal MRI Complementary Contributions to Appropriate Counseling in Small Bowel Obstruction. Fetal Diagn Ther 2021; 48(8): 567-74. doi: 10.1159/000517728. Epub 2021 Aug 30. PMID: 34461616. Xinyi Bian,Xiao Yang,Xinwei Shi, et al. Whole-exome sequencing applications in prenatal diagnosis of fetal bowel dilatation. [J].Open Life Sci,2023,18(1):20220598. doi: 10.1515/biol-2022-0598. PMID: 37215495; PMCID: PMC10199320. 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7714564","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":545911467,"identity":"faa1cc77-255f-4567-a183-928c844eebd7","order_by":0,"name":"Shaohua Wang","email":"","orcid":"","institution":"The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease","correspondingAuthor":false,"prefix":"","firstName":"Shaohua","middleName":"","lastName":"Wang","suffix":""},{"id":545911470,"identity":"edad9aa7-5abe-4bc0-8760-8e17bc87334a","order_by":1,"name":"xinying Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYDACZiBOAGIDBgbGBwkVNqRpYTZ4cCaNBNuAWtgkH7YdIkLlcd5jEg931Nqbs/eYVSSwHWDgb+9OwKtFspkvTSLxzHFmy54zZjcSeO4wSJw5uwGvFn5mHjOJxLZjbAY3coBaJJ4xGEjk4tfCBtXCA9JSkGBwmLAWqC01EiAtDAkJRGiRbOYxtkhsO2BgcOZYsUTCgTQegn4xOH/G8ObPtjp7g+PNGz/+/Gcjx9/ei18LELBIMDAchvN4CCkHAeYPDAx1xCgcBaNgFIyCkQoAqiBGONIvcm4AAAAASUVORK5CYII=","orcid":"","institution":"The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease","correspondingAuthor":true,"prefix":"","firstName":"xinying","middleName":"","lastName":"Zhou","suffix":""},{"id":545911472,"identity":"00de8513-f16a-45eb-8126-25b1488e32cd","order_by":2,"name":"Ruifang Chen","email":"","orcid":"","institution":"The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease","correspondingAuthor":false,"prefix":"","firstName":"Ruifang","middleName":"","lastName":"Chen","suffix":""},{"id":545911473,"identity":"7a397a8c-9fbb-4003-b9e7-1f00206cd8c5","order_by":3,"name":"Bin Yang","email":"","orcid":"","institution":"The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Yang","suffix":""},{"id":545911474,"identity":"ff6cc8ee-706a-451f-b55a-70532227fa4b","order_by":4,"name":"Linxue Guan","email":"","orcid":"","institution":"The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease","correspondingAuthor":false,"prefix":"","firstName":"Linxue","middleName":"","lastName":"Guan","suffix":""},{"id":545911475,"identity":"567c7344-db26-438e-95f5-9b5e62392fff","order_by":5,"name":"Wenxiao Wen","email":"","orcid":"","institution":"The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease","correspondingAuthor":false,"prefix":"","firstName":"Wenxiao","middleName":"","lastName":"Wen","suffix":""},{"id":545911476,"identity":"47db6eb1-cf1d-4910-8f56-4af888810403","order_by":6,"name":"Shanshan Zhao","email":"","orcid":"","institution":"The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease","correspondingAuthor":false,"prefix":"","firstName":"Shanshan","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2025-09-25 15:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7714564/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7714564/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96201018,"identity":"3bfcc4ba-b72d-44ec-98d5-1d1f5a75e1f1","added_by":"auto","created_at":"2025-11-18 16:32:13","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58206,"visible":true,"origin":"","legend":"","description":"","filename":"FetalIntestinalDilatationandDigestiveTractAbnormalitiesAnAnalysisof94Casesfrom16090DeliveriesinEasternTianjin.1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7714564/v1/cdce0468351fbbededa747f2.docx"},{"id":96201019,"identity":"b03d9b79-5fd8-4e6a-b2ba-bfb69a942e8e","added_by":"auto","created_at":"2025-11-18 16:32:13","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9077,"visible":true,"origin":"","legend":"","description":"","filename":"90d5cdc2c238471aab19e7c951614c05.json","url":"https://assets-eu.researchsquare.com/files/rs-7714564/v1/0a62ed9fa76e0021fe4bb7ad.json"},{"id":96201021,"identity":"b0dfc5c8-eb75-4348-8889-d27ca61d2ddd","added_by":"auto","created_at":"2025-11-18 16:32:13","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81778,"visible":true,"origin":"","legend":"","description":"","filename":"90d5cdc2c238471aab19e7c951614c051enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7714564/v1/cb7565c35db3dab3641f3018.xml"},{"id":96252211,"identity":"1c878208-88dd-4398-a083-316f76df7074","added_by":"auto","created_at":"2025-11-19 07:40:40","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79401,"visible":true,"origin":"","legend":"","description":"","filename":"90d5cdc2c238471aab19e7c951614c051structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7714564/v1/033c4d3adf9654b8ea4cc55e.xml"},{"id":96252991,"identity":"e4d49c09-a3ea-463d-854c-b8fe9e1969f8","added_by":"auto","created_at":"2025-11-19 07:41:46","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88482,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7714564/v1/b35cd35b5f340eb054c10bd2.html"},{"id":96455151,"identity":"17a7ae76-082c-49af-b963-0a835006e4a8","added_by":"auto","created_at":"2025-11-21 10:03:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":700485,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7714564/v1/d8a20070-8b21-404a-8445-8351ad149632.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fetal Intestinal Dilatation and Digestive Tract Abnormalities: An Analysis of 94 Cases from 16,090 Deliveries in Eastern Tianjin","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the continuous advancement of ultrasound technology, prenatal ultrasound screening for fetal developmental abnormalities, including those of the fetal intestines, has become increasingly accurate. Multiple studies have indicated that fetal intestinal dilatation may suggest a poor digestive system prognosis \u003csup\u003e[1-2]\u003c/sup\u003e. In clinical practice, it has been observed that some children with a history of fetal intestinal dilatation indeed exhibit abnormal development of the digestive system. However, it has also been noted that some newborns diagnosed with congenital structural abnormalities of the digestive system had no abnormal findings on prenatal ultrasound. Thus, there appears to be no clear consensus regarding whether prenatal ultrasound can reliably indicate structural abnormalities of the digestive system in newborns. To address this issue, this article reviews and analyses relevant cases from our hospital over a period of approximately five years.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"1 Information and methods","content":"\u003cp\u003e1.1 The study cohort comprised a total of 94 cases, incorporating data from all patients presenting with prenatal fetal intestinal dilatation, structural abnormalities of the digestive system in the newborn, or functional digestive disorders of unclear aetiology, between 1 January 2021 and 31 May 2025. For cases involving functional disorders, perinatal factors such as preterm birth, low birth weight, small for gestational age, perinatal asphyxia, infection, and hypoglycaemia were excluded. The gestational ages ranged from 35⁺⁶ to 41⁺⁴ weeks, with a mean gestational age of 39⁺\u0026sup3; weeks.\u003c/p\u003e\n\u003cp\u003e1.2 The examinations were performed using GE (USA) Voluson E10 and Voluson E8 colour Doppler ultrasound diagnostic systems, equipped with two-dimensional convex array probes operating at a frequency of 2\u0026ndash;5 MHz.\u003c/p\u003e\n\u003cp\u003e1.3 Research methods and diagnostic criteria\u003c/p\u003e\n\u003cp\u003eThe prenatal ultrasound examination primarily involved the measurement of fetal growth parameters and structural assessment, including but not limited to the location, internal diameter, and extent of any identified intestinal dilatation. The \u0026ldquo;double-bubble sign\u0026rdquo; was defined as the communication between the gastric bubble, located in the left upper abdomen, and the dilated proximal duodenum, situated in the right upper abdomen, via the pylorus\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[3]\u003c/sup\u003e. The small intestine is typically located in the mid-abdomen, while the colon is positioned peripherally in the lower abdomen and exhibits haustral markings. A small intestinal diameter exceeding 7 mm or a colonic internal diameter greater than 18 mm was considered indicative of intestinal dilatation \u003csup\u003e[4]\u003c/sup\u003e. Polyhydramnios was diagnosed when the amniotic fluid index exceeded 250 mm. Umbilical cord abnormalities included cord entanglement (e.g., nuchal cord), torsion, prolapse, excessive length (\u0026gt;100 cm), short cord (\u0026lt;30 cm), and single umbilical artery. Placental abnormalities encompassed morphological anomalies (such as succenturiate placenta, membranous placenta, and annular placenta), abnormal implantation (including placenta praevia and placenta accreta), and functional disorders (such as placental insufficiency and placental abruption).\u003c/p\u003e\n\u003cp\u003e1.4 Normality of the measurement data was assessed using SPSS 26.0 software. Differences between the two groups were evaluated using the t-test for normally distributed data. For categorical data, differences between groups were analysed by means of the chi-square (\u0026chi;\u0026sup2;) test. A \u003cem\u003ep\u003c/em\u003e-value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"2. Results","content":"\u003cp\u003e2.1 Between 1 January 2021 and 31 May 2025, there were 16,090 deliveries in our hospital. Among these, 27 neonates were diagnosed with structural abnormalities of the digestive tract. These cases included 17 instances of congenital anal stenosis, 2 of congenital anal atresia, 3 of congenital megacolon, 2 of intestinal atresia, and one case each of annular pancreas, gastric duplication, and duodenal web. Additionally, 67 cases presented with functional disorders of the digestive system, comprising 3 cases of meconium plug syndrome and 6 cases of gastroesophageal reflux. The remaining cases, for which no clear cause was identified, resolved following conservative medical management.\u003c/p\u003e\n\u003cp\u003eAmong the 27 cases with structural abnormalities of the digestive tract, 17 cases (63%) exhibited abnormal findings on prenatal intestinal ultrasound. These included one case each of gastric duplication, duodenal web, and annular pancreas (demonstrating a double-bubble sign), all of which involved the upper digestive tract and were clearly identified during prenatal screening. These anomalies were detected between 24 and 36 weeks of gestation and were subsequently confirmed by postnatal surgery. The remaining cases presented with intestinal dilatation, measuring between 1.4 cm and 2.3 cm in width, and were identified at gestational ages ranging from 35⁺\u0026sup1; to 40⁺⁶ weeks. Among the 10 cases with no abnormal prenatal ultrasound findings, six were diagnosed postnatally with congenital anal stenosis, two with congenital megacolon, one with congenital anal atresia, and one with intestinal obstruction, all representing structural abnormalities of the lower digestive tract.\u003c/p\u003e\n\u003cp\u003ePrenatal ultrasound detected abnormalities in 51 of the 67 cases (76%) with functional digestive disorders. All presented with fetal intestinal dilatation, measuring between 1.5 cm and 2.8 cm in width, which was identified at gestational ages ranging from 33⁺\u0026sup2; to 40⁺⁶ weeks.\u003c/p\u003e\n\u003cp\u003eDuring the study period, the annual proportion of digestive system abnormalities detected by prenatal ultrasound relative to the number of deliveries was 0.04% (2/4125) in 2021, 0.1% (5/4816) in 2022, 0.1% (4/3256) in 2023, 0.5% (20/3481) in 2024, and 2% (35/1700) between January and May 2025, demonstrating a marked year-on-year increase.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.2 There was no statistical significance in comparison between structural problems and functional problems in newborn digestive system(Table 1). The mean values of the abnormal expansion of the intestinal tube were 1.76+265 cm and 1.88+240 cm respectively, and there was no statistical significance (\u003cem\u003eF\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e= 0.266, \u003cem\u003et\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e= 1.539, \u003cem\u003eP\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e= 0.129) between the two groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1.\u0026nbsp;Comparison of prenatal ultrasound\u0026nbsp;detection rates\u0026nbsp;between\u0026nbsp;neonates\u0026nbsp;with structural and functional\u0026nbsp;digestive tract abnormalities\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eAntenatal intestinal abnormalities\u0026nbsp;detected, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;antenatal\u0026nbsp;intestinal abnormalities\u0026nbsp;detected, n\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eStructured problem\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003efunctional problem\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-1.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e2.3 Maternal age, hypertension, diabetes, hypothyroidism, and the rate of non-Lactococcus colonisation showed no significant differences between the two groups of mothers of neonates with structural or functional digestive system abnormalities(Table 2). Similarly, no significant differences were observed between the two groups in infant gender, amniotic fluid volume, umbilical cord abnormalities, placental abnormalities, birth order, or head circumference(Table 3). However, significant differences were identified in birth weight and birth length(Table 3), but not in neutrophil count, lymphocyte count, haemoglobin level, platelet count, liver function, and calcium and phosphorus metabolism(Table 4).\u003c/p\u003e\n\u003cp\u003eTable 2. Comparison\u0026nbsp;of\u0026nbsp;perinatal characteristics and infant sex between neonates\u0026nbsp;with structural and functional\u0026nbsp;digestive tract abnormalities\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStructural abnormalities group (n = 27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional disorders group (n = 67)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eHypertension, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.449\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eDiabetes, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eHypothyroidism, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eNon-\u003cem\u003eLactococcus\u003c/em\u003e colonisation, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-1.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerinatal factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eAmniotic fluid abnormality,\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.865\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eUmbilical cord abnormalities,\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003ePlacental abnormalities,\u003c/p\u003e\n \u003cp\u003en \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eMale,\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3.\u0026nbsp;Comparison of\u0026nbsp;maternal\u0026nbsp;and\u0026nbsp;neonatal characteristics between structural\u0026nbsp;and functional\u0026nbsp;digestive tract abnormality groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStructural abnormalities group (n = 27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional disorders group (n = 67)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003eMaternal age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e29.81 \u0026plusmn; 4.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e30.19 \u0026plusmn; 3.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e1.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eNeonatal parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eBirth order\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.00 \u0026plusmn; 1.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e1.72 \u0026plusmn; 0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e1.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-1.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eHead circumference (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e33.84 \u0026plusmn;\u0026nbsp;1.649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e33.89 \u0026plusmn;\u0026nbsp;1.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4.564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.884\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eBirth length (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e49.33 \u0026plusmn; 2.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e50.63 \u0026plusmn; 1.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e3.427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eBirth weight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e3.091 \u0026plusmn;\u0026nbsp;0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e3.411 \u0026plusmn;\u0026nbsp;0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4.\u0026nbsp;Comparison of postnatal\u0026nbsp;biochemical and haematological parameters between neonates\u0026nbsp;with\u0026nbsp;structural\u0026nbsp;and functional\u0026nbsp;digestive tract abnormalities\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStructural abnormalities group (n = 27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional disorders group (n = 67)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaematological parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eNeutrophils (\u0026times;10⁹/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e11.318 \u0026plusmn; 5.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e13.524 \u0026plusmn; 5.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eLymphocytes (\u0026times;10⁹/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e3.658 \u0026plusmn; 1.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e4.091 \u0026plusmn; 1.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e173.590 \u0026plusmn; 22.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e174.130 \u0026plusmn; 18.430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003ePlatelets (PLT, \u0026times;10⁹/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e253.440 \u0026plusmn; 65.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e269.660 \u0026plusmn; 50.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiochemical parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eAlbumin (ALB, g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e37.415 \u0026plusmn; 3.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e37.886 \u0026plusmn; 2.964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e10.220 \u0026plusmn; 4.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e11.647 \u0026plusmn; 5.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eGGT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e182.540 \u0026plusmn; 126.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e145.530 \u0026plusmn; 99.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e-1.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eTotal bile acids (TBA, \u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e5.988 \u0026plusmn; 3.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e5.468 \u0026plusmn; 3.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e-0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eCalcium (Ca, mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2.335 \u0026plusmn; 0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2.370 \u0026plusmn; 0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003ePhosphorus (P, mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.700 \u0026plusmn; 0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.623 \u0026plusmn; 0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e-1.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eMagnesium (Mg, mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.806 \u0026plusmn; 0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.773 \u0026plusmn; 0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e-2.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: HGB, haemoglobin; PLT, platelets; ALB, albumin; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase; TBA, total bile acids; Ca, calcium; P, phosphorus; Mg, magnesium.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThe aetiology of fetal intestinal dilatation\u003csup\u003e\u0026nbsp;[5]\u003c/sup\u003e can be\u0026nbsp;broadly categorised as\u0026nbsp;functional\u0026nbsp;or\u0026nbsp;structural,\u0026nbsp;with an approximate incidence ratio of\u0026nbsp;1:1. Functional\u0026nbsp;causes most commonly include\u0026nbsp;meconium\u0026nbsp;plug\u0026nbsp;syndrome\u0026nbsp;and\u0026nbsp;meconium\u0026nbsp;ileus, whereas structural causes are frequently related to meconium\u0026nbsp;peritonitis, congenital intestinal atresia, congenital megacolon,\u0026nbsp;intestinal\u0026nbsp;malrotation, gastrointestinal\u0026nbsp;duplication, anorectal atresia or stenosis,\u0026nbsp;and\u0026nbsp;cystic fibrosis. Functional intestinal abnormalities often\u0026nbsp;carry\u0026nbsp;a\u0026nbsp;favourable\u0026nbsp;prognosis\u0026nbsp;following medical management, whereas\u0026nbsp;structural\u0026nbsp;anomalies typically necessitate\u0026nbsp;surgical intervention.\u0026nbsp;A poor prognosis is more likely if the condition is\u0026nbsp;not detected early and\u0026nbsp;managed proactively. Ultrasonography offers considerable\u0026nbsp;advantages in clinical\u0026nbsp;practice due to its convenience\u0026nbsp;and\u0026nbsp;ongoing technical advancements. Consequently, it is\u0026nbsp;widely\u0026nbsp;employed\u0026nbsp;in\u0026nbsp;prenatal\u0026nbsp;intestinal screening.\u0026nbsp;It\u0026nbsp;is\u0026nbsp;therefore\u0026nbsp;of\u0026nbsp;significant\u0026nbsp;clinical\u0026nbsp;importance\u0026nbsp;to\u0026nbsp;understand\u0026nbsp;the specificity and sensitivity of ultrasound in\u0026nbsp;detecting\u0026nbsp;structural\u0026nbsp;abnormalities\u0026nbsp;of the digestive system\u0026nbsp;in\u0026nbsp;newborns.\u003c/p\u003e\n\u003cp\u003eThis study reviewed cases of children with structural digestive tract abnormalities at our centre over a five-year period. Gastric duplication, duodenal web, and annular pancreas were all accurately identified by prenatal ultrasound, with findings consistent with surgical outcomes. All three conditions are upper gastrointestinal tract abnormalities and were detected at an earlier\u0026nbsp;gestational age. Previous studies \u003csup\u003e[6-7]\u003c/sup\u003e have also reported that structural abnormalities of the upper gastrointestinal tract are more likely to demonstrate abnormal imaging features as early as 9-12 weeks of gestation. Annular pancreas tends to be detectable earlier than duodenal anomalies \u003csup\u003e[2]\u003c/sup\u003e, and both conditions exhibit high sensitivity and specificity on prenatal ultrasound. It is noteworthy that prenatal ultrasound often reveals obstruction or blockage of the proximal intestinal segment rather than the intrinsic structural mal-formation of the bowel itself. Precise localisation of the obstructed intestinal segment remains challenging \u003csup\u003e[8]\u003c/sup\u003e. Some studies \u003csup\u003e[9]\u003c/sup\u003e indicate\u0026nbsp;that the site of small intestinal atresia\u0026nbsp;occurs\u0026nbsp;more\u0026nbsp;frequently\u0026nbsp;in the distal jejunum, and\u0026nbsp;that\u0026nbsp;the sensitivity and specificity of\u0026nbsp;diagnosis\u0026nbsp;are higher when fetal small\u0026nbsp;intestinal dilatation reaches\u0026nbsp;11.5 cm. In\u0026nbsp;the present\u0026nbsp;study, annular pancreas\u0026nbsp;was accurately\u0026nbsp;diagnosed\u0026nbsp;prenatally by ultrasound\u0026nbsp;through\u0026nbsp;identification of\u0026nbsp;the \u0026quot;double bubble sign\u0026quot;. Similarly,\u0026nbsp;gastric\u0026nbsp;duplication\u0026nbsp;and duodenal\u0026nbsp;web\u0026nbsp;were clearly\u0026nbsp;demonstrated\u0026nbsp;by prenatal imaging,\u0026nbsp;achieving\u0026nbsp;an accuracy of 100%.\u0026nbsp;Attention\u0026nbsp;should\u0026nbsp;also\u0026nbsp;be\u0026nbsp;given\u0026nbsp;to the suggestive\u0026nbsp;value\u0026nbsp;of\u0026nbsp;the\u0026nbsp;\u0026quot;vortex sign\u0026quot;\u0026nbsp;for\u0026nbsp;intestinal malrotation\u0026nbsp;complicated by\u0026nbsp;intestinal obstruction \u003csup\u003e[10]\u003c/sup\u003e.\u0026nbsp;This\u0026nbsp;study also\u0026nbsp;observed\u0026nbsp;that\u0026nbsp;more proximal\u0026nbsp;obstruction\u0026nbsp;sites tend to present\u0026nbsp;earlier\u0026nbsp;on\u0026nbsp;ultrasound, while more distal obstructions are detected\u0026nbsp;later. Consequently, when\u0026nbsp;abnormal\u0026nbsp;findings\u0026nbsp;in the\u0026nbsp;fetal\u0026nbsp;upper gastrointestinal tract are\u0026nbsp;identified\u0026nbsp;during pregnancy, obstetricians should actively coordinate with\u0026nbsp;neonatology\u0026nbsp;and\u0026nbsp;paediatric\u0026nbsp;surgery\u0026nbsp;departments to facilitate early\u0026nbsp;perioperative\u0026nbsp;planning.\u003c/p\u003e\n\u003cp\u003eIn this study, prenatal ultrasound findings of lower digestive tract structural abnormalities presented with intestinal dilatation; however, no statistically significant difference was observed in either the detection rate of prenatal intestinal dilatation or its magnitude when compared to cases with functional disorders. This finding contrasts with some studies suggesting that greater intestinal dilatation is associated with a higher likelihood of poor prognosis \u003csup\u003e[11]\u003c/sup\u003e. This discrepancy may be attributed to the timing of diagnosis: in the present study, intestinal dilatation was predominantly identified during the late stage of pregnancy, with most cases detected within two weeks prior to delivery. This indicates that in-testinal dilatation in late gestation is not necessarily indicative of a structural ab-normality. This observation aligns with other studies \u003csup\u003e[12]\u003c/sup\u003e which report that transient dilatation of the fetal small intestine or colon can represent a normal physiological variant. Furthermore, the late stage of pregnancy imposes limitations on the frequency of dynamic monitoring of the intestinal tract. In most instances, intestinal dilatation was only transiently observed shortly before delivery, indicating that the sensitivity and specificity of detecting fetal intestinal dilatation in late gestation for identifying structural abnormalities of the neonatal digestive system are limited. This study also revealed that cases of structural abnormalities which were not detected by prenatal ultrasound all involved lower digestive tract developmental anomalies, including congenital megacolon, anal atresia, and anal stenosis. This observation is consistent with findings from other studies\u0026nbsp;\u003csup\u003e[13]\u003c/sup\u003e. It is suggested that\u0026nbsp;structural abnormalities of\u0026nbsp;the lower digestive tract\u0026nbsp;in\u0026nbsp;newborns are\u0026nbsp;prone to being overlooked\u0026nbsp;during prenatal ultrasound examination. Careful\u0026nbsp;attention should be\u0026nbsp;given\u0026nbsp;to excluding\u0026nbsp;the presence of\u0026nbsp;\u0026quot;target signs\u0026quot; and \u0026quot;funnel signs\u0026quot; \u003csup\u003e[14-15]\u003c/sup\u003e, and further\u0026nbsp;evaluation\u0026nbsp;should be\u0026nbsp;conducted\u0026nbsp;using two-dimensional ultrasound \u003csup\u003e[16]\u003c/sup\u003e.\u0026nbsp;Concurrently, clinicians\u0026nbsp;should perform\u0026nbsp;detailed physical\u0026nbsp;examinations, maintain\u0026nbsp;close clinical observation, and\u0026nbsp;undertake\u0026nbsp;necessary postnatal imaging\u0026nbsp;studies\u0026nbsp;to\u0026nbsp;accurately assess\u0026nbsp;the newborn\u0026rsquo;s condition.\u003c/p\u003e\n\u003cp\u003eThe observed intestinal dilatation in late pregnancy, associated with functional disorders of the neonatal digestive system, is related to the developmental characteristics of the fetal intestinal tract. The fetal intestine undergoes continuous development throughout gestation, with its diameter gradually increasing as gestational age advances. The average diameter of the small intestine measures approximately 3 mm at 20\u0026ndash;21 weeks and progressively increases to a maximum of 14 mm. Similarly, the diameter of the colon and rectum increases from 3\u0026ndash;4 mm at 18\u0026ndash;19 weeks to 8\u0026ndash;15 mm by 20 weeks. The anal sphincter complex develops gradually during the fetal period, with anal maturation typically beginning around 22 weeks. Meconium formation starts at approximately 13 weeks and consists mainly of ingested amniotic fluid, necrotic epithelial cells, gastrointestinal gland secretions, and bile. During the mid to late stages of pregnancy, the fetal gastrointestinal tract begins to exhibit emptying and peristaltic movements, facilitating the gradual migration of meconium from the small intestine to the colon and rectum. Over time, the pressure exerted by the fetal anal sphincter increases. By around 20 weeks, a functional outlet obstruction may develop, leading to the accumulation of meconium within the intestines. The ingested amniotic fluid can be reabsorbed by the colon; however, as meconium continues to accumulate within the colon and rectum, the intestinal tract undergoes significant dilatation, thereby becoming detectable by ultrasound. In addition to structural abnormalities, numerous other factors, particularly in late pregnancy, can contribute to fetal intestinal dilatation. Functional factors such as meconium obstruction or transient intestinal ischaemia may lead to transient intestinal dilatation\u0026nbsp;\u003csup\u003e[17]\u003c/sup\u003e. After\u0026nbsp;birth, following spontaneous\u0026nbsp;defecation or\u0026nbsp;assisted evacuation of\u0026nbsp;meconium,\u0026nbsp;or\u0026nbsp;upon restoration of\u0026nbsp;blood supply, the obstruction\u0026nbsp;resolves\u0026nbsp;and the intestinal tract returns to\u0026nbsp;its\u0026nbsp;normal\u0026nbsp;state. This\u0026nbsp;observation is consistent with the findings of\u0026nbsp;this study,\u0026nbsp;in which\u0026nbsp;many\u0026nbsp;neonates\u0026nbsp;with prenatal ultrasound\u0026nbsp;evidence of\u0026nbsp;intestinal\u0026nbsp;dilatation exhibited no\u0026nbsp;abnormal clinical symptoms or signs after\u0026nbsp;delivery\u0026nbsp;and\u0026nbsp;were able to\u0026nbsp;achieve full enteral feeding\u0026nbsp;promptly following\u0026nbsp;defecation.\u003c/p\u003e\n\u003cp\u003eTherefore, the findings of this study highlight to clinicians that even a small degree of intestinal dilatation in late pregnancy may indicate a structural abnormality, while more pronounced dilatation could be associated with a functional disorder. It is not feasible to rely solely on the magnitude of intestinal dilatation to predict the nature of the underlying condition. Consequently, clinicians should maintain a high level of vigilance when managing such cases. A careful differential diagnosis should be performed to promptly identify structural abnormalities, enabling timely surgical intervention and reducing the risk of adverse prognostic outcomes.\u003c/p\u003e\n\u003cp\u003eTo improve the accuracy of prenatal diagnosis, serial ultrasound examinations at intervals of two to four weeks may be performed for cases with abnormal prenatal intestinal findings. Dynamic monitoring of intestinal width is recommended; progressive dilatation carries greater clinical significance \u003csup\u003e[18]\u003c/sup\u003e. Additional sonographic soft markers, such as anechoic areas, enhanced echogenicity, or polyhydramnios, may also be incorporated into the diagnostic evaluation. In cases where intestinal dilatation is detected early, the ratio of intestinal width to gestational age can be calculated; a lower value may be of greater clinical relevance. If multiple ultrasound indicators are abnormal, further investigation with magnetic resonance imaging (MRI) may be warranted. MRI can delineate the extent and location of intestinal dilatation and provide characteristic signal patterns on T1-weighted and T2-weighted sequences, which may offer clues regarding the site and nature of the abnormality \u003csup\u003e[19-22]\u003c/sup\u003e. For cases with high suspicion of intestinal developmental anomalies, prenatal whole-exome sequencing may be considered to assist in diagnosis\u003csup\u003e\u0026nbsp;[23]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn this study, neonates with structural abnormalities exhibited significantly lower postnatal weight and length compared to those with functional disorders, although both parameters remained within the normal range. To date, there are no published research data directly addressing this observation. Given that malformations of the digestive system may potentially affect fetal growth, vigilance is advised regarding the possibility of digestive tract abnormalities in neonates presenting with lower birth weight. No statistically significant differences were observed between the two groups in the incidence of common pregnancy complications or abnormalities of the umbilical cord and placenta, suggesting that these maternal factors have no predictive value for structural anomalies of the neonatal digestive system. Similarly, postnatal blood investigations showed no significant differences between the groups, indicating that structural abnormalities did not compromise the stability of the intrauterine environment.\u003c/p\u003e\n\u003cp\u003eIn summary, structural abnormalities of the upper gastrointestinal tract in newborns may be detected earlier and present more distinctly on prenatal ultrasound. Once identified, prompt postnatal assessment and diagnostic intervention are required. In contrast, structural anomalies of the lower digestive tract cannot be reliably diagnosed by prenatal ultrasound alone. Following delivery, paediatricians should undertake a timely differential diagnosis based on clinical symptoms, physical signs, and postnatal imaging studies to prevent delays in diagnosis and treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHGB, haemoglobin;\u003c/p\u003e\n\u003cp\u003ePLT, platelets;\u003c/p\u003e\n\u003cp\u003eALB, albumin;\u003c/p\u003e\n\u003cp\u003eALT, alanine aminotransferase;\u003c/p\u003e\n\u003cp\u003eGGT, gamma-glutamyl transferase\u003c/p\u003e\n\u003cp\u003eTBA, total bile acids;\u003c/p\u003e\n\u003cp\u003eCa, calcium\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;P, phosphorus;\u003c/p\u003e\n\u003cp\u003eMg, magnesium.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. All research methods were carried out in accordance with the relevant guidelines and regulations. The parents or legal guardians of all participants were informed consent to participate in this study. This study was approved by the Medical Research Ethics Professional Committee of the Third Central Hospital of Tianjin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from Corresponding author, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available upon reasonable request and with permission of Medical Research Ethics Professional Committee of the Third Central Hospital of Tianjin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Science and technology support project of Tianjin (21ZXGWSY00040).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003eThe Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Centre, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China.\u003c/p\u003e\n\u003cp\u003eShaohua Wang, xinying Zhou, Ruifang Chen, Bin Yang, Linxue Guan, Wenxiao Wen, Shanshan Zhao.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Xinying Zhou.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Shaohua Wang wrote the manuscript text and prepared all figures.XinyingZhou supervised the manuscript. Ruifang Chen designed the study. Bing Yang \u0026nbsp;provided secured funding .Linxue Guan,Wenxiao Wen and Shanshan Zhao assisted in data collection. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to all the experts who helped them with this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eXuelei Li,Meng Zhou,Shanshan Wang, et al. The role of multimodal ultrasound in diagnosis of fetal bowel dilatation and prediction of adverse neonatal outcomes: A study of 86 cases in a series of 43,562 births[J].Heliyon,2024,10(5):e27455. doi: 10.1016/j.heliyon.2024.e27455. PMID: 38463772; PMCID: PMC10923836.\u003c/li\u003e\n\u003cli\u003eJiang Y, Wang W, Pan W, Wu W, Zhu D, Wang J. Study of Correlation between Fetal Bowel Dilation and Congenital Gastrointestinal Malformation. Children (Basel). 2024 May 31;11(6):670. doi: 10.3390/children11060670. PMID: 38929249; PMCID: PMC11201953.\u003c/li\u003e\n\u003cli\u003eYan Yingliu, Yang Xiuxiong. Prenatal ultrasound diagnosis [M]. 2nd edition. Beijing: People\u0026apos;s Military Medical Press, 2012: 364-369.\u003c/li\u003e\n\u003cli\u003eEberhard M. ultrasound in Obstertrics and Gynecilogy,second edition,Geory Thieme Verlag,Stuttgart,Germany.2002:596.\u003c/li\u003e\n\u003cli\u003eCorteville JE. Gray DL, Lanfer JC. Bowel abnormalities in the fetus-correlation of prenatal ultrasonographic findings with out-come[J] Am J Obstet Gynecol.1996,175:724-729. doi: 10.1053/ob.1996.v175.a74412. PMID: 8828441.\u003c/li\u003e\n\u003cli\u003eLi X, Zhao Z, Li X, Zhao M, Kefei H. Appearance of fetal intestinal obstruction on fetal MRI. Prenat Diagn 2020; 40(11): 1398-1407. doi: 10.1002/pd.5779. Epub 2020 Aug 18. PMID: 32594545.\u003c/li\u003e\n\u003cli\u003eDemirci O, Eri\u0026ccedil; \u0026Ouml;zdemir M, Kumru P, Celayir A. Clinical significance of prenatal double bubble sign on perinatal outcome and literature review[J]. J Matern Fetal Neonatal Med 2022; 35(10): 1841-7. doi: 10.1080/14767058.2021.1874338. Epub 2021 Jan 17. PMID: 33455511.\u003c/li\u003e\n\u003cli\u003eLv Z, Qu H, Hu J, Dong Y, Liu W. Analysis of Ileal Atresia from Prenatal Ultrasound to Postoperative Follow-up: Two Case Reports[J]. Curr Med Imaging. 2024;20:e15734056292576. doi: 10.2174/0115734056292576240426050921. PMID: 38693743.\u003c/li\u003e\n\u003cli\u003eGao Y, Ru Y, Han H, Yin H, Yin P, Gao Y. Prenatal Ultrasound Diagnosis and Clinical Analysis of Fetal Small Bowel Obstruction[J]. Curr Med Imaging. 2023 Nov 7. doi: 10.2174/0115734056262425231031171130. Epub ahead of print. PMID: 37957877.\u003c/li\u003e\n\u003cli\u003eYang L, Chen H, Lv G, Li F, Liao J, Ke L. Evaluation of ultrasonography in fetal intestinal malrotation with midgut volvulus[J]. Ginekol Pol. 2022;93(4):296-301. doi: 10.5603/GP.a2021.0237. Epub 2022 Feb 14. PMID: 35156693.\u003c/li\u003e\n\u003cli\u003eCao Hui, Deng Xuedong. Analysis of the correlation between fetal intestinal dilation and pregnancy outcomes [J].Chinese Journal of Medical Ultrasound (Electronic Edition), 2014, 11 (07): 46-49\u003c/li\u003e\n\u003cli\u003eXiang Jinlian, Yan Yingliu, Kong Fanbin, etc. Prenatal ultrasound diagnosis and clinical outcome analysis of fetal intestinal dilation [J]. Tumor Imaging, 2021, 30(02): 114-118.DOI:10.19732/j.cnki.2096-6210.2021.02.010.\u003c/li\u003e\n\u003cli\u003eA Syngelaki,R Mitsigiorgi,J Goadsby, et al. Routine 36-week scan: diagnosis of fetal abnormalities[J].Ultrasound Obstet Gynecol,2025,65(4):427-435. doi: 10.1002/uog.29218. Epub 2025 Mar 25. PMID: 40131231; PMCID: PMC11961102.\u003c/li\u003e\n\u003cli\u003eHaiyan Kuang,Hui Cao,Sheng Wang, et al. New ultrasound features in diagnosing fetal anal atresia: a multicenter prospective cohort study [J].Sci Rep,2024,14(1):22821.\u003c/li\u003e\n\u003cli\u003eDaglar HK, Kaymak D. Beyond the Target Sign: Two Cases of Low-Type Anal Atresia Diagnosed Prenatally With Fetal Perineal Imaging[J]. J Clin Ultrasound. 2025,53(7):1648-1652. doi: 10.1002/jcu.70008. Epub 2025 Jul 11. PMID: 40644566.\u003c/li\u003e\n\u003cli\u003eT Elkan Miller,T Weissbach,M Elkan, et al. Infracoccygeal/transperineal window: new method to prenatally diagnose and classify level of anal atresia[J]. Ultrasound Obstet Gynecol,2024,64(4):521-527. doi: 10.1002/uog.29094. Epub 2024 Sep 1. PMID: 39219041.\u003c/li\u003e\n\u003cli\u003eGhi T,Tani G，CarlettiA，et al. Transient bowel ischaemia of the fetus[J]. Fetal Diagn Ther, 2005,20(1):54-7. doi: 10.1159/000081370. PMID: 15608461.\u003c/li\u003e\n\u003cli\u003eSuting Xu,Wei Zhong,Zhuanxing Shen, et al. Analysis of the clinical outcomes of fetal bowel dilatation combined with other abnormal ultrasonographic features[J]. J Matern Fetal Neonatal Med,2019,32(6):992-996. doi: 10.1080/14767058.2017.1397123. Epub 2017 Nov 7. PMID: 29113511.\u003c/li\u003e\n\u003cli\u003eLiu Sanchun, Li Xiao Hu, Yin Chuangao, et al. The value of MRI in the diagnosis of fetal digestive tract obstruction [J]. Journal of Clinical Radiology, 2022, 41: 923-927.\u003c/li\u003e\n\u003cli\u003eXia Yanyu, Yang Wenzhong, Lan Weishun, etc.The diagnostic value of MRI in fetal intestinal dilation [J]. Journal of Clinical Radiology, 2023, 42(09): 1493-1496.\u003c/li\u003e\n\u003cli\u003eZhang Zhengwei, Yin Qiufeng, Zhang Yuzhen, etc. MRI diagnosis and clinical outcome analysis of fetal intestinal dilation [J]. Journal of Clinical Radiology, 2022, 41(10): 1962-1967.\u003c/li\u003e\n\u003cli\u003eDidier-Mathon H, Gr\u0026eacute;vent D, Khen-Dunlop N, et al. Ultrasound and Fetal MRI Complementary Contributions to Appropriate Counseling in Small Bowel Obstruction. Fetal Diagn Ther 2021; 48(8): 567-74. doi: 10.1159/000517728. Epub 2021 Aug 30. PMID: 34461616.\u003c/li\u003e\n\u003cli\u003eXinyi Bian,Xiao Yang,Xinwei Shi, et al. Whole-exome sequencing applications in prenatal diagnosis of fetal bowel dilatation. [J].Open Life Sci,2023,18(1):20220598. doi: 10.1515/biol-2022-0598. PMID: 37215495; PMCID: PMC10199320.\u003c/li\u003e\n\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":"Fetus, Intestinal dilatation, Digestive system abnormalities","lastPublishedDoi":"10.21203/rs.3.rs-7714564/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7714564/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis study aimed to investigate the association between structural abnormalities of the digestive system in newborns and prenatal ultrasound findings of fetal intestinal dilatation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective analysis was conducted using clinical data from neonates with digestive tract abnormalities delivered at the Third Central Hospital of Tianjin between 1 January 2021 and 31 May 2025.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 27 neonates were diagnosed with structural abnormalities of the digestive tract. These included 17 cases of congenital anal stenosis, 2 cases of congenital anal atresia, 3 cases of congenital megacolon, 2 cases of intestinal atresia, 1 case of annular pancreas, 1 case of gastric duplication, and 1 case of duodenal web. Additionally, 67 cases were identified with functional digestive system disorders, comprising 3 cases of meconium plug syndrome and 6 cases of gastroesophageal reflux. The remaining cases, which lacked a clear aetiology, were successfully resolved following conservative medical management. No statistically significant difference was observed between the two groups in the rate of abnormal prenatal ultrasound findings or in the degree of intestinal dilatation. Furthermore, there were no significant differences in maternal age, parity, incidence of hypertension, diabetes, hypothyroidism, or in abnormalities related to amniotic fluid, umbilical cord, or placenta. Significant differences were identified in birth weight and birth length; however, no significant differences were found in head circumference, neutrophil count, lymphocyte count, haemoglobin level, platelet count, liver function tests, or calcium and phosphorus metabolism.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eStructural abnormalities of the upper digestive tract in newborns may present earlier and be more readily detectable on prenatal ultrasound imaging. In contrast, structural abnormalities of the lower gastrointestinal tract may not exhibit clear anomalous features on prenatal ultrasound. Therefore, reliance solely on prenatal ultrasound examination for diagnostic investigation is not recommended. Clinicians should perform a timely differential diagnosis after birth based on clinical symptoms and signs to avoid delays in diagnosis and treatment.\u003c/p\u003e","manuscriptTitle":"Fetal Intestinal Dilatation and Digestive Tract Abnormalities: An Analysis of 94 Cases from 16,090 Deliveries in Eastern Tianjin","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 16:32:08","doi":"10.21203/rs.3.rs-7714564/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":"f9a154d3-d11e-4c9c-b260-51a668de320c","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-21T05:38:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 16:32:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7714564","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7714564","identity":"rs-7714564","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}