The Colon in the Healthy Newborn Infant

Abstract

In spite of the rarity of roentgen examinations of the colon of the newborn infant in routine practice, it is necessary for the radiologist to have a well founded knowledge of the appearance of the normal colon at this and subsequent ages. This paper presents the roentgen findings on barium enema study of the colon in a group of 105 healthy newborn infants, of whom 51 were white and 54 colored. Fifty-three were boys and 52 girls. None of these babies had any gastro-intestinal disturbances. They were, with 6 exceptions, full-term children, varying in age from two to eight days. The smallest infant weighed at birth 2,385 grams; the largest, 4,755 grams. Two of the mothers had positive tests for syphilis. The remainder were serologically negative. The infant is even less co-operative than some of our adult patients. Consequently, one must have at hand a simple but satisfactory method for examining the large bowel. After an opaque meal has been given, barium can be seen entering the cecum and ascending colon in three to six hours, and in eight hours the entire colon may be visualized (6). Distribution of the meal throughout the colon, however, is so scattered that a satisfactory view is rarely obtained. Not only is it difficult at times to distinguish between ileum and large bowel, but in one infant the meal may have only entered the cecum in eight hours, while in another evacuation of the head of the barium column may have occurred. This may necessitate roentgen study at least at hourly intervals, and after all this work one may have adequate information only on colonic motility, and little or none on form and size. It is, therefore, evident that the colon is best examined by administration of a barium enema. Larimore made barium enema studies on 102 newborn babies, ranging in age from six and a half hours to thirty days (8). He found that frequently the right colon and the cecum could not be filled. Complete failure of the colon to fill was often encountered because of its intolerance to the enema. Larimore's work demonstrated variations in total length and regional topography of the infant's colon, analogous to those seen in the adult. Local redundancies and hyperrotation and descent of the cecum with increased total length of the right colon were observed. Bryant measured intestines removed at autopsy from 45 fetuses, 37 children, ranging in age from six months to seventeen years, and 160 adults (3). He concluded that the most striking characteristic of the human intestine is extreme variation in length, this variation averaging about 100 per cent. Variation in length, Bryant found, begins at or before the fifth month of intra-uterine existence and thereafter is evident throughout life in both the small and large bowel. The characteristic 100 per cent variation in length is present at birth as at all later periods of life.