Monday, 16 July 2018

Monash medical student’s research provides more certainty for neonates with gastro-intestinal abnormalities

Ashleigh Laird
Fourth year medical student Ms Ashleigh Laird presented her research into neonatal gastro-intestinal anomalies at the 17th  Fetal Medicine Foundation (FMF) world congress in Athens last month.

The scientific meeting attracts leading international experts and researchers on the latest developments in fetal medicine, and was attended by 2400 delegates.

Undertaken while a third year student at Monash Medical Centre and the School of Clinical Sciences at Monash Health (SCS), Ashleigh completed a retrospective review of the data at Monash Health of all foetuses who were found to have particular markers, bowel echogenicity and bowel dilatation, on antenatal ultrasound.

“These have been known to be associated with a number of conditions including cystic fibrosis, chromosomal abnormalities and foetal growth restriction,” Ashleigh said.

“However, we were looking to see if the presence of isolated bowel echogenicity or the presence of both bowel echogenicity and bowel dilatation increases the risk of gastro-intestinal anomalies in the foetuses at birth.”

Ashleigh also undertook a systematic review and meta-analysis of all the available literature that included post-natal outcomes, investigating the presence or absence of gastrointestinal anomalies in these children. 

“The outcomes of both studies showed that having both bowel echogenicity and bowel dilatation together increased the risk of gastrointestinal anomalies, whereas when bowel echogenicity was found alone, the risk of a gastrointestinal anomaly at birth is very low.”

At Monash health, paediatric surgeons are often involved in antenatal counselling, and there is a need to understand the implications of particular antenatal findings, especially if there is an increased risk of the child needing surgery at birth.

Ashleigh’s projects have clarified local and international experiences, providing the most up-to-date information relevant to the teams involved in the perinatal care of these vulnerable children.

“When echogenic bowel and dilated bowel are diagnosed on ultrasound there is uncertainty surrounding whether or not the child will require surgery at birth,” Ashleigh said.

“From our own experience and from the systematic review, we found that when echogenic bowel is found alone, there is a very low risk, less than 3%, of needing surgery at birth, however, when dilated bowel and echogenic bowel are found concurrently, there is 50% chance of the child needing surgery at birth, because of the increased risk of conditions such as meconium ileus and biliary atresia.”

“Having this information will allow paediatric surgeons to prepare for the birth of the child and inform the parents of the management that may be required in the first few days of the child’s life.”

“Additionally, because these markers are often found quite early in the pregnancy, averaging around 21 weeks’ gestation, some parents may consider whether to continue with the pregnancy or not based on the results of the ultrasound scans and the information given to them by the paediatric surgeon.”

Ashleigh’s research now enables parents to make a more informed decision regarding the pregnancy as the paediatric surgeon can better inform them of the possible outcomes and what these results mean for their child. 

Ashleigh acknowledges and thanks Dr Maurizio Pacilli, Mr Ram Nataraja and Mr Paul Shekleton for their invaluable support and assistance.

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