{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T13:37:16Z","timestamp":1756993036616,"version":"3.40.5"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,1,7]],"date-time":"2024-01-07T00:00:00Z","timestamp":1704585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Med Imag Rad Onc"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Fortified expressed breast milk (FEBM) is a standard of care for premature and low birth weight neonates, but comes with an elevated risk of a rare but re\u2010emergent pathology called milk curd obstruction (MCO). Little is known about normal sonographic appearances of bowel contents in this feeding setting, making the recognition of abnormalities difficult. Thus, we aimed to describe appearances that may be considered typical pre\u2010 and post\u2010fortifier inclusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ten neonates of &lt;32\u2009weeks' gestation or a birth weight of &lt;1,800\u2009g recruited from Auckland City Hospital Neonatal Intensive Care between 1\/5\/2019 and 10\/9\/2019 received bowel ultrasounds within 24\u2009h before and 10\u201314\u2009days after starting FEBM. Bowel contents in six abdominal regions were assigned scores of 1\u20136 based on increasing solidification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Lower gestational age was correlated with more solid contents on the pre\u2010fortifier ultrasound (<jats:italic>P<\/jats:italic>\u2009=\u20090.02). Fortifier was significantly associated with increasing solidity, particularly in the left abdomen (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The left lower quadrant and rectum accounted for much of this change (<jats:italic>P<\/jats:italic>\u2009=\u20090.012 and <jats:italic>P<\/jats:italic>\u2009=\u20090.002). One subject who subsequently developed a clinical picture consistent with early MCO had uniquely demonstrated non\u2010rectal solid contents (score 6). The interobserver kappa score for two assessors was 0.91 (95% CI 0.94\u20130.99) on still images.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This small cohort demonstrated increasing bowel content solidification after breast milk fortification using a novel ultrasound scoring system with good interobserver agreement. Non\u2010rectal solid contents (score 6) appeared atypical. Ultrasound shows promise for its non\u2010irradiating diagnostic utility in the setting of early milk curd disease evaluation of the premature neonate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1754-9485.13617","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T05:54:18Z","timestamp":1704693258000},"page":"150-157","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Curds in the way: A milk curd obstruction review and normal sonographic bowel appearances using a novel scoring system in neonates on fortified breast milk feeds"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1429-8974","authenticated-orcid":false,"given":"Lara L","family":"Kimble","sequence":"first","affiliation":[{"name":"Department of Paediatric Radiology Starship Hospital  Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Paediatric Radiology Starship Hospital  Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katinka P","family":"Bach","sequence":"additional","affiliation":[{"name":"Newborn Intensive Care Unit Starship Hospital  Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,1,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.52.1.68"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00441532"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-003-0968-7"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(89)80412-9"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-43-516-856"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-200X.2012.03630.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15545"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01995867"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000494625"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3468(69)90486-2"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/131.2.409S"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/131.2.426S"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)93304-8"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.4103\/jcn.JCN_51_19"},{"key":"e_1_2_7_16_1","first-page":"895","article-title":"Lactobezoar and necrotizing enterocolitis in a preterm infant","volume":"5","author":"Mandel D","year":"2003","journal-title":"Isr Med Assoc J"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2014.02.054"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2021.01.008"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2008.01460.x"},{"key":"e_1_2_7_20_1","first-page":"148","article-title":"Ceacal perforation in a premature newborn infant complicating milk curd syndrome: case report","volume":"14","author":"Karkiner A","year":"2003","journal-title":"Turk J Gastroenterol"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/ped.12082"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/ped.14364"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-11002-0070"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajum.12114"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2352031718"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-018-4077-0"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000000397"},{"key":"e_1_2_7_28_1","unstructured":"CormackB BellhouseS Newborn Services Clinical Practice Committee.Nutrition \u2013 neonatal nutrition guideline [Internet]. Starship Child Health 2021. [Cited 23 Apr 2022.] Available from URL:https:\/\/starship.org.nz\/guidelines\/nutrition\u2010neonatal\u2010nutrition\u2010guideline\/."},{"key":"e_1_2_7_29_1","unstructured":"Department for Health and Wellbeing Government of South Australia.South Australian neonatal medication guidelines. Nutrient delivery comparison tables: preterm infants [Internet].2019. [Cited 23 Apr 2022.] Available from URL:https:\/\/www.sahealth.sa.gov.au\/wps\/wcm\/connect\/14e027d5\u2010a21b\u201040d1\u201084e8\u20103b03d9b1bc8a\/Nutrient+delivery+comparison+tables_Preterm+Infants_Neo_v1.0.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE\u201014e027d5\u2010a21b\u201040d1\u201084e8\u20103b03d9b1bc8a\u2010nKPh694."},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e31827fb091"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.118.084418"}],"container-title":["Journal of Medical Imaging and Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1754-9485.13617","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T00:42:09Z","timestamp":1711586529000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1754-9485.13617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,7]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/1754-9485.13617"],"URL":"https:\/\/doi.org\/10.1111\/1754-9485.13617","archive":["Portico"],"relation":{},"ISSN":["1754-9477","1754-9485"],"issn-type":[{"type":"print","value":"1754-9477"},{"type":"electronic","value":"1754-9485"}],"subject":[],"published":{"date-parts":[[2024,1,7]]},"assertion":[{"value":"2023-08-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}