Portal Vein Gas in Neonates: Predicting Clinical Treatment Outcomes From Ultrasound Findings.

Abstract

To identify sonographic findings that predict clinical outcomes in neonates with portal vein gas. This retrospective study included neonates with portal vein gas detected using ultrasound (US). The US images were reviewed by a pediatric radiologist. US findings included the extent and amount of portal vein gas, mesenteric vein gas, intramural gas, bowel wall thickening or thinning, focal discontinuity of the bowel wall, ascites, free intra-abdominal gas, pseudocyst, gas in the other solid organs, and bowel distension. The imaging findings and demographic factors between survivors and non-survivors were statistically compared. The mortality rate was 26% (39 survivors, 14 non-survivors) when iatrogenic and idiopathic causes were excluded. The causes of portal vein gas were determined to be necrotizing enterocolitis (n=33), bowel distension or obstruction (n=12), fetal hydrops (n=4), pneumothorax (n=3), immediate postoperative state for bowel perforation (n=1), and umbilical vein catheterization (n=9) based on surgical findings (n=20) and clinical information (n=46). Gas within the mesenteric vein and the other solid organs, gestational age, and birth weight were significantly different between survivors and those who succumbed (P < .05). Gas within the mesenteric vein and other solid organs is a US finding that may predict poor outcomes in neonates with portal vein gas.