Implications of antenatal diagnosis of small-intestinal atresia in the 1990s

To assess the prevalence of antenatal diagnosis of small-intestinal atresia s (SIA) in the modern era and determine its effect on management and outcom e, the records of neonates admitted to a single institution in 1991-1996 wi th a diagnosis of SIA were reviewed. Duodenal atresia, atresias complicatin g meconium ileus, and those associated with gastroschisis mere excluded. Of 14 neonates with SIA, 10 had jejunal atresia (JA) (Grosfeld type I, n = 1; type II, n = 2; type IIIa, 3; type IIIb [apple peel], n = 3; type IV, n = I) and 4 had ileal atresia (IA) (type II, n = 1; type IIIa, n = 3). Antenat al diagnosis was made in 4 neonates (overall rate = 28%), including all 3 t ype IIIb JA, and I type II JA. None of the IAs were diagnosed antenatally. There were 2 deaths, both in patients with high JAs with less than 10 cm vi able bowel. Only 1 of these was antenatally diagnosed. The median (range) t imes to full enteral feeding were 20 days (17-22) for antenatally-diagnosed JA, 14 days (11-26) for other JAs, and 8 days (6-15) for IAs. Antenatal di agnosis of SIA thus remains relatively infrequent (less than one-third of c ases). When an antenatal diagnosis is made, the atresia is more likely to b e proximal in location, requiring intensive and prolonged postnatal treatme nt. Provided a reasonable length of bowel remains, the outcome of SIA, whet her antenatally diagnosed or not, is favorable.