Iranian Journal of Neonatology

Iranian Journal of Neonatology

Neonatal Abdominal Distension: A Spectrum of Causes and Clinical Outcomes in a Tertiary NICU

Document Type : Original Article

Authors
Roya Oboodi
Behnaz Erfani
Hamide Barzegar
Zahra Hashemi
Seyed Mostajab Razavinejad
Mehrdad Rezaei
Reza Bahrami
Khadijeh Sadat Najib
Fariba Hemmati
Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
10.22038/ijn.2026.91135.2769
Abstract
Background: Abdominal distension is a common and potentially serious presentation in neonatal intensive care units (NICUs). This study aimed to investigate the etiologies, management, and outcomes of neonates with abdominal distension in a tertiary referral center in southern Iran.
Methods: This retrospective cross-sectional study included all neonates admitted with abdominal distension to Namazi Hospital, Shiraz, from September 2021 to September 2024. Data were obtained from hospital records using a structured checklist and analyzed with SPSS version 26. The Mann–Whitney U test was used for continuous variables and the Chi-square test for categorical variables, with p < 0.05 considered significant.
Results: A total of 171 neonates were included, 109 (63.7%) male and 62 (36.3%) female, with a mean age at presentation of 10.5 ± 12.1 days, gestational age of 35.6 ± 4.5 weeks, and birth weight of 2775.5 ± 781.6 g. Obstructive causes were found in 84 (49.1%) cases and non-obstructive in 87 (50.9%). The most frequent etiologies were unknown (19.9%), imperforate anus (19.9%), and Hirschsprung disease (18.1%). Congenital anomalies were present in 35.7%, mainly congenital heart disease (81.9%). Compared with non-obstructive cases, the obstructive group presented earlier (5.0 ± 8.3 vs. 14.0 ± 13.6 days, p < 0.001), had higher birth weight (2889.6 ± 711.1 vs. 2597.0 ± 725.1 g, p = 0.043), and longer hospital stay (10.9 ± 10.3 vs. 7.4 ± 6.7 days, p = 0.007). Overall mortality was 12.1%, with no significant group difference (p = 0.28).
Conclusion: Neonatal abdominal distension was nearly equally due to obstructive and non-obstructive causes, with congenital malformations being major contributors. Early diagnosis, screening for anomalies, and timely intervention are essential to improve outcomes.
Keywords
Abdominal distension
Infant
Neonatal intensive care unit
Newborn
Treatment outcome
1.     Cheromcha DP, Hyman PE. Neonatal necrotizing enterocolitis. Inflammatory bowel disease of the newborn. Dig Dis Sci. 1988;33(3 Suppl):78S-84S.
2.     Chen A, Du J, Du LZ. [Clinical characteristics of abdominal distention in early newborns]. Zhongguo Dang Dai Er Ke Za Zhi. 2013;15(12):1074-1078. Chinese.
3.     Mimouni F, Hirsh M, Ovadia J, Reisner SH. Abdominal distension in very low birth weight, small for gestational age infants. Clin Pediatr (Phila). 1984;23(9):526.
4.     Khan MR, Maheshwari A, Robertson DJ, Khlevner J, Kapur RP, Sood MR. Persistent abdominal distension, bilious emesis, and feeding intolerance in an infant without anatomical bowel obstruction. JPGN Rep. 2024;6(1):65-68.
5.     Huang H, Huang J, Huang W, Huang N, Duan M. Breast milk jaundice affects breastfeeding: From the perspective of intestinal flora and SCFAs-GPR41/43. Front Nutr. 2023;10:1121213.
6.     Antezana VLE, Dorado JPH, Justiniano WM, Colque DMT, Parada VU, Arias PAC. ODP374 Abdominal Distention as a Unique Sign of Congenital Hypothyroidism. J Endocr Soc. 2022;6(Suppl 1): A598.
7.     Puri P, Nakamura H. Epidemiology and clinical characteristics of Hirschsprung’s disease. InHirschsprung's Disease and Allied Disorders. 2019;167-174. Cham: Springer International Publishing.
8.     Ali A, Haider F, Alhindi S. The Prevalence and Clinical Profile of Hirschsprung's Disease at a Tertiary Hospital in Bahrain. Cureus. 2021; 13(1):e12480.
9.     Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770-1780.
10.  Duess JW, Sampah ME, Lopez CM, Tsuboi K, Scheese DJ, Sodhi CP, et al. Necrotizing enterocolitis, gut microbes, and sepsis. Gut Microbes. 2023; 15(1):2221470.
11.  Davenport M, Spitz L, Coran A. Operative pediatric surgery: CRC press; 2013.
12.  Orun UA, Bilici M, Demirçeken FG, Tosun M, Ocal B, Cavusoglu YH. Gastrointestinal system malformations in children are associated with congenital heart defects. Anadolu Kardiyol Derg. 2011;11(2):146-149.
13.  Gokhroo RK, Gupta S, Arora G, Bisht DS, Padmanabhan D, Soni V. Prevalence of congenital heart disease in patients undergoing surgery for major gastrointestinal malformations: An Indian study. Heart Asia. 2015;7(1):29-31.
14.  Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364(3):255-264.
15.  Garg PM, Paschal JL, Ansari MAY, Block D, Inagaki K, Weitkamp JH. Clinical impact of NEC-associated sepsis on outcomes in preterm infants. Pediatr Res. 2022;92(6):1705-1715.
16.  Kariniotaki C, Thomou C, Gkentzi D, Panteris E, Dimitriou G, Hatzidaki E. Neonatal Sepsis: A Comprehensive Review. Antibiotics. 2025;14(1):6.
17.  Esposito F, Mamone R, Di Serafino M, Mercogliano C, Vitale V, Vallone G, et al. Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quant Imaging Med Surg. 2017;7(3):336-344.
18.  Yoseph BP, Klingensmith NJ, Liang Z, Breed ER, Burd EM, Mittal R, et al. Mechanisms of intestinal barrier dysfunction in sepsis. Shock. 2016;46(1):52-59.
19.  Gilfillan M, Bhandari V. Biomarkers for the diagnosis of neonatal sepsis and necrotizing enterocolitis: Clinical practice guidelines. Early Hum Dev. 2017;105:25-33.
20.  Hull NC, Kurian J, Garg H, Winant AJ, Lee EY, editors. Neonatal Bowel Emergencies: Practical Approach to Diagnosis. Seminars in Roentgenology; 2024: Elsevier.
21.  Roorda D, Abeln ZA, Oosterlaan J, van Heurn LW, Derikx JP. Botulinum toxin injections after surgery for Hirschsprung disease: Systematic review and meta-analysis. World J Gastroenterol. 2019; 25(25):3268-3280.
22.  Hasan MS, Islam N, Mitul AR. Neonatal Surgical morbidity and mortality at a single tertiary center in a low- and middle-income country: A retrospective study of clinical outcomes. Front Surg. 2022;9:817528.
23.  Wella H, Farahat S. Pattern and Management Outcomes of Neonatal Acute Surgical Conditions in Alexandria, Egypt. East and Central African Journal of Surgery. 2015;20(2):69-79.
24.  Ali I, Mufti GN, Bhat NA, Baba AA, Sheikh KA, Hamid R, et al. Assessment of predictors of mortality in neonatal intestinal obstruction. J Neonat Surg. 2018;7(1):2.
Iranian Journal of Neonatology
Volume 17, Issue 4
Autumn 2026
Pages 26-31