Early Ultrasound Signs of Splenomegaly in Neonates

The purpose of the study is to determine early non-invasive (ultrasound) diagnostic criteria of splenomegaly in neonates with a high risk of congenital or postnatal infection.

Materials and methods. In the prospective study, 163 newborn infants of the first week of live were included. All neonates included in the study were classified as possessing a high risk of an intra-uterine infection (IUI). Depending on the birth weight, the infants were split into two groups: group «А» — 80 full-term newborns with normal birth weight, and group «В» — 83 full-term newborns with fetal growth restriction (FGR). A comprehensive examination of newborns including spleen ultrasound was carried out.

Results. An increased spleen weight coefficient (Km) was found in newborns with high risk of infection development that included congenital oromaxillofacial and gastrointestinal defects, perinatal contacts with various microorganism. The increased spleen weight and Km reflected conditions of the immune system organ of the newborn in response to an adverse exposure including infection.

Conclusion. Ultrasound examination of morphometrical characteristics of the spleen in newborns with various medical conditions represents a convenient and simple method of early diagnosis of splenomegaly. The most sensitive index is the spleen weight coefficient (Km), which reflects the immune system organ response to an adverse perinatal exposure including contact with an infectious agent. The mean spleen weight coefficient is within the range of 1.1 to 3.0. When the index exceeds 4, the risk of development of an infectious disease increases. This method can be used as a screening approach for newborns of different gestation age who have been included in the high-risk group based on a congenital or early postnatal infection.

1. Dolgushina V.F., Dolgushin I.I., Kurnosenko I.V., Lebedeva Yu.V. Clinical and immunological criteria for intrauterine infection. Akush. Ginekol. 2017; 1: 40-45. [In Russ.] DOI: 10.18565/aig.2017.1.40-5.

2. Perepelitsa S.A., Smerdova E.F. Differential Diagnosis of Congenital Pneumonia in Newborns with Low and Extremely Low Body Weight (Morphological Study). Obshchaya reanimatologiya=General Reanimatology. 2018; 14 (4): 4-14. [In Russ., In Engl.] DOI: 10.15360/18139779-2018-4-4-14.

3. van Well G.T.J., Daalderop L.A., Wolfs T., Kramer B.W. Human perinatal immunity in physiological conditions and during infection. Mol Cell Pediatr. 2017; 4 (1): 4. DOI: 10.1186/s40348-017-0070-1. PMID: 28432664. PMCID: PMC5400776

4. Perepelitsa S.A., Vozgoment O.V. Spleen mass ratio is a new marker of intrauterine infection. Rossijskij immunologicheskij zhurnal.2018; 12 (24): 722-724. [In Russ.]

5. Xiao T., Chen L., Liu H., Xie S., Luo Y, Wu D. The analysis of etiology and risk factors for 192 cases of neonatal sepsis. Biomed. Res. Int. 2017: 8617076. DOI: 10.1155/2017/8617076. PMID: 28758124.

6. Fattah M.A., Omer А.F., Asaif S., Manlulu R., Karar T., Ahmed A., Aljada A., Saleh A.M., Qureshi S., Nasr A. Utility of cytokine, adhesion molecule and acute phase proteins in early diagnosis of neonatal sepsis. J. Nat. Sci. Biol. Med. 2017; 8 (1): 32–39. DOI: 10.4103/09769668.198362. PMID: 28250672.

7. Kollmann T.R., Levy O., Montgomery R.R., Goriely S. Innate immune function by Toll-like receptors: distinct responses in newborns and the elderly. Immunity. 2012; 37 (5): 771-783. DOI: 10.1016/j.immuni.2012.10.014. PMID: 23159225 PMCID: PMC3538030 DOI: 10.1016/j.immuni.2012.10.014

8. Xu Y.Y., Wang S.C., Li D.J., Du M.R. Co-Signaling Molecules in MaternalFetal Immunity. Trends Mol Med. 2017; 23 (1): 46-58. DOI: 10.1016/j.molmed.2016.11.001. PMID: 27914866.

9. Kumar S.K., Bhat B.V. Distinct mechanisms of the newborn innate immunity. Immunol Lett. 2016; 173: 42-54. DOI: 10.1016/j.imlet. 2016.03.009. PMID: 26994839.

10. Sinnott B.D., Park B., Boer M.C., Lewinsohn D.A., Lancioni C.L. Direct TLR-2 Costimulation Unmasks the Proinflammatory Potential of Neonatal CD4+ T Cells. J Immunol. 2016; 197 (1): 68-77. DOI: 10.4049/jimmunol.1501297. PMID: 27194790.

11. Rotbain E. C., Hansen D. L., de Muckadell O., Wibrand F., Lund A. M, Frederiksen H. Splenomegaly – Diagnostic validity, work-up, and underlying causes. PLoS One. 2017; 12 (11): e0186674. DOI: 10.1371/journal.pone.0186674. PMCID: PMC 5685614.

12. Vancauwenberghe T., Snoeckx A., Vanbeckevoort D., Dymarkowski S., Vanhoenacker F.M. Imaging of the spleen: what the clinician needs to know. Singapore Med J. 2015; 56 (3): 133-144. PMID: 25820845. PMCID: PMC4371192.

13. Hilmes M.A., Strouse P.J. The pediatric spleen. Semin Ultrasound CT MR. 2007; 28 (1): 3-11. PMID: 17366703.

14. Moreira M., Bras R., Goncalves D., Alencoao I., Inocencio G., Rodrigues M., Braga J. Fetal Splenomegaly: A Review. Ultrasound Q. 2018; 34 (1): 32-33. DOI: 10.1097/RUQ.0000000000000 335. PMID: 29194292.

15. Nemati M., Hajalioghli P., Jahed S., Behzadmehr R., Rafeey M., Fouladi D.F. Normal Values of Spleen Length and Volume: An Ultrasonographic Study in Children. Ultrasound Med Biol. 2016; 42 (8): 1771-1778. DOI: 10.1016/j.ultrasmedbio.2016.03.005. PMID: 27108037.

16. Pelizzo G., Guazzotti M., Klersy C., Nakib G., Costanzo F., Andreatta E., Bassotti G., Calcaterra V. Spleen size evaluation in children: Time to define splenomegaly for pediatric surgeons and pediatricians. PLoS One. 2018; 13 (8): e0202741. DOI: 10.1371/journal.pone.0202741. PMCID: PMC6107197.

17. Kahramaner Z., Erdemir A., Arik B., Bilgili G., Tekin M, Genc Y. Reference ranges of liver and spleen dimensions in term infants: sonographic measurements. J Med Ultrason. 2015; 42 (1): 77-81. DOI: 10.1007/s10396-014-0578-0. PMID: 26578493.

18. Volodin N.N. (ed.). Neonatology. National guidelines. М.: GEOTARMedia; 2009. [In Russ.]

19. Vozgoment O.V., Pykov M.I., Zajtseva N.V. New approaches to ultrasound estimation of spleen size in children. Ultrazv. i funkc. diagnostika. 2013; 6: 56-62 [In Russ.]

20. Back S.J., Maya C.L., Khwaja A. Ultrasound of congenital and inherited disorders of the pediatric hepatobiliary system, pancreas and spleen. Pediatr Radiol. 2017; 47 (9): 1069-1078. DOI: 10.1007/s00247017-3869-y.