title: Bedside upper gastrointestinal series in critically ill low birth weight infants.
abstract: BACKGROUND
  The upper gastrointestinal (UGI) series is the preferred method for the diagnosis of malrotation. A bedside UGI technique was developed at our institution for use in low birth weight, critically ill neonates to minimize the risks of transportation from the neonatal intensive care unit (NICU) such as hypothermia and dislodgement of support lines and tubes.
  
  
  OBJECTIVE
  To determine the ability of a bedside UGI technique to identify the position of the duodenojejunal junction (DJJ) in low birth weight, critically ill infants in the NICU.
  
  
  METHODS
  We retrospectively reviewed bedside UGI examinations performed in premature infants weighing less than 1,500 g from 2008 to 2013 and correlated the findings with clinical data, imaging studies and surgical findings.
  
  
  RESULTS
  Of 27 patients identified (weight range: 633-1,495 g), 21 (78%) bedside UGI series were diagnostic. Twenty of 27 cases (74%) demonstrated normal intestinal rotation. One case demonstrated malrotation with midgut volvulus, which was confirmed at surgery. In six cases (22%), the position of the DJJ could not be accurately determined. No cases of malrotation with midgut volvulus were missed. None of the patients with normal bedside UGI studies was found to have malrotation based on clinical follow-up (mean: 20 months), surgical findings or further imaging.
  
  
  CONCLUSIONS
  The bedside UGI is a useful technique to exclude malrotation in critically ill neonates and minimizes potential risks of transportation to the radiology suite. Pitfalls that may preclude a diagnostic examination include incorrect timing of radiographs, patient rotation, suboptimal enteric tube position and bowel distention. In cases of diagnostic uncertainty, a follow-up study should be performed.
authors.affiliation: Department of Radiology, Division of Pediatric Radiology, Montefiore Medical Center, 111 East 210 St., Bronx, NY, 10467, USA.
authors.forename: Gopi K
authors.initials: GK
authors.lastname: Nayak
authors.forename: Terry L
authors.initials: TL
authors.lastname: Levin
authors.forename: Jessica
authors.initials: J
authors.lastname: Kurian
authors.forename: Anirudh
authors.initials: A
authors.lastname: Kohli
authors.forename: Steven H
authors.initials: SH
authors.lastname: Borenstein
authors.forename: Harold S
authors.initials: HS
authors.lastname: Goldman
mesh_terms: D004065:Digestive System Abnormalities; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000151:congenital* / Q000000981:diagnostic imaging; D008297:Male; D015588:Observer Variation; D056888:Patient Positioning / Q000379:methods*; D019095:Point-of-Care Systems; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*