Early prednisone treatment and nephropathy in anaphylactoid purpura

Abstract

In a review of 11 cases of intra-uterine intussusception, 8 presented with vomiting as an important symptom, 7 had abdominal distention [2]. The mortality was high, 7 infants died. Stine [3] and Kelly [1] each reported one case of intra-uterine intussusception in a premature infant. Similar to our patients, the infants developed RDS. The clinical symptoms were initially misinterpreted as NEC, and the patients were treated conservatively until the correct diagnosis was made at explorative laporatomy. Since NEC is far more common than intussusception this condition was first considered in our patients. The prevalence of congenital intussusception based on our findings is about 1/170.000 newborns, while the incidence of NEC in the premature infant has been reported as high as 12% [4]. However, to confirm the clinical diagnosis of NEC, one of two radiological signs are needed: intramural intestinal gas (pneumatosis) or intrahepatic portal venous gas. Quite often these patients will also have radiological signs of intestinal perforation. In our first patient none of these signs were present, in the second case only intestinal perforation was found. The second infant was also examined with abdominal ultrasound, although this did not help in the diagnosis. Since treatment for NEC is usually conservative and surgery is only indicated after intestinal perforation [4] the correct diagnosis was first made during explorative laparatomy. One might speculate that the delay in surgery of 13 days in pa: tient 1 and 33 days in patient 2 influenced the result. We therefore conclude that when a diagnosis of NEC is made, but the clinical course varies from the expected, other diagnoses, such as intussusception, must be considered. High resolution abdominal ultrasound examination may be of value in suspected cases of intussusception in the newborns.