Am J Perinatol
DOI: 10.1055/a-2308-2151
Original Article

Defining an Evaluation Protocol for the Infant with Fetal Echogenic Bowel

Kendall Alsup
1   Medical College of Georgia at Augusta University, Augusta, Georgia
Jessica L. Pearson
2   The Wellness Collective, Sioux Falls, South Dakota
Andrew Bowe
3   Division of Neonatology, Spartanburg Regional Healthcare System, Spartanburg, South Carolina
Padmashree C. Woodham
4   Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, Georgia
› Author Affiliations


Objective This study aimed to develop an algorithm for pediatricians to use for infants diagnosed with fetal echogenic bowel (FEB) to ensure that each patient is fully evaluated for possible complications while avoiding unnecessary morbidity and mortality and health care-associated costs.

Study Design This was a prospective cohort of neonates for which a diagnosis of FEB was made during a Level 2 anatomy ultrasound between February 2016 and January 2017. Women diagnosed with FEB were offered perinatal genetic counseling and testing. These women also received increased third trimester fetal surveillance, including daily fetal kick counts, fetal growth scans every 3 to 4 weeks beginning at 28 weeks, and weekly fetal nonstress test (NST) and/or BPP beginning at 32 weeks. After delivery, neonates received a postnatal evaluation including birth weight, gestational age at birth, presence of other abnormalities, and associated perinatal morbidity and mortality. Comparison between findings was performed using chi-square test. All statistical evaluation was performed using SPSS.

Results Among 919 pregnant patients who received Level 2 anatomy ultrasounds at a Regional Perinatal Center during the study period, 70 received a diagnosis of FEB. Of those diagnosed with FEB, 52 (74.3%) delivered at the same Regional Medical Center. Of these 52 delivered infants, 3 (5.8%) were intrauterine fetal demises (IUFDs) and 4 (7.6%) had unaffected twins. Only one multifetal gestation had the diagnosis of FEB in both the twins. Only 19 of the infants delivered had a kidney, ureter, and bladder X-ray (KUB) performed secondary to prematurity or abnormal exams.

Conclusion This study showed that the majority of infants diagnosed with FEB had a normal exam following delivery, and that most of the neonatal outcomes of neonatal intensive care unit admissions and other neonatal complications are a result of prematurity rather than FEB. Although the algorithm did not have significant results, it is easy to follow and implement in larger studies.

Key Points

  • Majority of infants with FEB have a normal physical exam after delivery.

  • Majority of neonatal outcomes evaluated were a result of prematurity rather than FEB.

  • FEB is a soft marker for potential abnormalities and fetal morbidity/mortality.

Publication History

Received: 14 July 2023

Accepted: 15 April 2024

Accepted Manuscript online:
17 April 2024

Article published online:
16 May 2024

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