title: Antenatal prognostic factor of fetal echogenic bowel.
abstract: OBJECTIVE
  The aim of this study was to identify antenatal prognostic factors of neonatal outcomes in cases of fetal echogenic bowel (FEB).
  
  
  METHODS
  A retrospective study in three tertiary referral centers including fetal echogenic bowel over a 10-year period (from January 2003 to December 2013). The echogenicity of the fetal bowel was graded from 1 to 3, according to Slotnick's definition. Associated echographic findings such as bowel dilations, gallbladder abnormalities, calcifications, extra-abdominal abnormalities, intrauterine growth restriction (IUGR) and a decrease in amniotic fluid volume, if present were also recorded. This was followed by the FEB's sonographic evolution. The sonographic evolution was considered favorable if it was stable or decreasing and unfavorable if the echogenicity of the bowel increased or if additional sonographic findings appeared. Neonates had a pediatric examination in the delivery room and upon discharge from the maternity hospital. An outcome was considered good in the case of on-term delivery of a newborn with normal clinical examination and meconium elimination.
  
  
  RESULTS
  Complete pregnancy outcome data were available for 409 pregnancies. 338 newborns had uneventful outcomes (82.6%). Antenatal exploration diagnosed 4 cases of aneuploidy (1 case of trisomy 13, 1 case of trisomy 18 and 2 cases of triploidies), 16 cases of congenital infections, 9 cases of cystic fibrosis and 11 cases of bowel abnormalities. After a multivariate analysis, we discovered the sonographic grade of the echogenic bowel was not a prognostic factor of neonatal outcome. The isolated fetal echogenic bowel had a 6.6-fold increase chance of uneventful outcomes (adjusted odd ratio (aOR) 6.6, 95% CI 3-14.4). Notably, favorable sonographic evolution (aOR 8.1, 95% CI 4.1-16) and late gestational age at the time of the diagnosis (aOR 1.17, 95% CI 1.07-1.27) are independent, good prognostic factors of good neonatal outcomes. None of the 180 fetuses with isolated fetal echogenic bowel and favorable sonographic evolution had adverse outcomes. Among these, 4 cases (0.98%) of aneuploïdy, 17 cases (4.2%) of congenital infections and 9 cases (2.2%) of cystic fibroses were also diagnosed. No cases of Down syndrome (DS) were reported.
  
  
  CONCLUSIONS
  Our study shows that the grade should not be considered a prognostic factor of neonatal outcomes. Our data suggests the need to reevaluate the concept of systematic amniocentesis. Sonographic evolution of fetal bowel is an independent, strong prognostic factor for good neonatal outcomes. It also better defines the FEB prognostic.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital of Grenoble, F-38700 La Tronche, France; Department of Gynecology and Obstetrics, Pole femme enfant, Marseille, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université and A*MIDEX «CREER» (n° ANR-11-IDEX-0001-02), France. Electronic address: Candice.RONIN@ap-hm.fr.
authors.forename: Candice
authors.initials: C
authors.lastname: Ronin
authors.affiliation: Department of Gynecology and Obstetrics, Pole femme enfant, Marseille, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université and A*MIDEX «CREER» (n° ANR-11-IDEX-0001-02), France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mace
authors.affiliation: Digestive and Oncology Unit, Mutualiste Hospital of Grenoble, F-38000, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Stenard
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.affiliation: Department of Gynecology and Obstetrics, Pole femme enfant, Marseille, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université and A*MIDEX «CREER» (n° ANR-11-IDEX-0001-02), France; Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, INSERM, GMGF UMR_S 910, 13385 Marseille, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Capelle
authors.affiliation: Department of Gynecology and Obstetrics, Pole femme enfant, Marseille, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université and A*MIDEX «CREER» (n° ANR-11-IDEX-0001-02), France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mortier
authors.affiliation: Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, INSERM, GMGF UMR_S 910, 13385 Marseille, France.
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Pellissier
authors.affiliation: Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, INSERM, GMGF UMR_S 910, 13385 Marseille, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Sigaudy
authors.affiliation: Department of Gynecology and Obstetrics, Pole femme enfant, Marseille, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université and A*MIDEX «CREER» (n° ANR-11-IDEX-0001-02), France.
authors.forename: Annie
authors.initials: A
authors.lastname: Levy
authors.affiliation: Department of Gynecology and Obstetrics, Pole femme enfant, Marseille, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université and A*MIDEX «CREER» (n° ANR-11-IDEX-0001-02), France.
authors.forename: Claude
authors.initials: C
authors.lastname: D'ercole
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital of Grenoble, F-38700 La Tronche, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Hoffmann
authors.affiliation: Pediatric Surgery, North and Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Merrot
authors.affiliation: Pediatric Surgery, North and Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lopater
authors.affiliation: Pediatric Surgery, North and Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: De Lagausie
authors.affiliation: Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, INSERM, GMGF UMR_S 910, 13385 Marseille, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Philip
authors.affiliation: Department of Gynecology and Obstetrics, Pole femme enfant, Marseille, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université and A*MIDEX «CREER» (n° ANR-11-IDEX-0001-02), France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France; Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, INSERM, GMGF UMR_S 910, 13385 Marseille, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
mesh_terms: D000328:Adult; D058535:Echogenic Bowel / Q000145:classification / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal
keywords: Echogenic bowel; Neonatal outcome; Prognostic factors; Sonographic evolution