Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Abstract

OBJECTIVE: This study aimed to identify the most useful ultrasound (US) features associated with definite neonatal necrotizing enterocolitis (NEC) and their prognostic values, particularly the calculated markers combined with important features. METHODS: A total of 213 suspected NEC cases were collected from the neonatal department of our hospital from January 2015 to August 2017. Each infant received both X-ray and US examinations. RESULTS: No differences were found in sex composition and delivery modes between groups. NEC-positive neonates had poorer prognosis compared to negative ones. The NEC group showed a higher frequency of abnormal signals. US showed higher NEC-related frequencies in different parameters. A variable (named predictor in US [PUS]) with five features was constructed. For NEC diagnosis, this variable provided a much higher area under the curve Q2 (AUC) (0.965) than other parameters. In this model, PUS had a cutoff value of 0.376 with a 0.900 sensitivity and 0.922 specificity. In prognosis, the closest factors were selected to draw a receiver operating characteristic curve, as well as a novel calculated variable US prognostic (USPro) marker. USPro had a much higher AUC (0.86) than other single features and showed a cutoff value of 0.18145, with 0.75 sensitivity and 0.84 specificity. This variable had a weaker power in prognosis when compared with PUS in diagnosis. CONCLUSIONS: The application of abdominal color Doppler US can provide high accuracy and sensitivity in NEC diagnosis and also contribute to its prognosis, without induction of radiation. Suspected neonates should be examined using this technique as early as possible.

Value of abdominal ultrasonography in predicting intestinal resection for premature infants with necrotizing enterocolitis

“…Feingold et al [ 23 ] measured the intestinal wall thickness of 30 children without gastrointestinal diseases, 22 children with NEC and 8 children with suspected NEC and found that the intestinal wall of children with NEC was thickened or thinned to varying degrees, among which the intestinal wall of 8 children with severe NEC was thinned, and the follow-up found that all 8 children had intestinal necrosis. This study confirmed that the course of NEC is accompanied by a change in intestinal wall thickness, and the intestinal wall thickness in the early stage of NEC displays nonuniform thickening [ 24 , 25 ]. This finding is consistent with the results of the present study showing that the intestinal wall thickness of infants with stage I and II NEC is thicker than that of infants with bowel loss.…”

Application of abdominal ultrasonography in surgical necrotizing enterocolitis: a retrospective study

“…Key AUS features of NEC were observed carefully (Tam et al, 2002 ; Faingold et al, 2005 ; Epelman et al, 2007 ; Silva et al, 2007 ; Muchantef et al, 2013 ; Patel et al, 2015 ; Allin et al, 2017 ; Erinumberger, 2017 ; Chen et al, 2018 ; Faingold, 2018 ; Markel and Underwood, 2018 ; Ben Fadel et al, 2019 ; van Druten et al, 2019 ; Miller et al, 2020 ; Tracy et al, 2020 ; Alexander et al, 2021 ; Chan et al, 2021 ; Gao et al, 2021 ; Kotb et al, 2021 ; Cuna et al, 2022 ; Hwang et al, 2022 ). These features included (1) bowel wall thickness: normal between 1 and 2–2.7 mm; (2) decreased intestinal peristalsis: intestinal peristalsis <10 times/min.…”

“…These features included (1) bowel wall thickness: normal between 1 and 2–2.7 mm; (2) decreased intestinal peristalsis: intestinal peristalsis <10 times/min. (3) Pneumatosis intestinalis (PI): granular, stripe, ring-shaped hyperechoic foci in the intestinal wall; (4) portal venous gas (PVG): movable granular hyperechoic foci within the portal vein and its branches; (5) pneumoperitoneum: free intraperitoneal air seen as echogenic foci or stacked echogenic lines outside the bowel lumen; (6) ascites: detectable free liquid dark areas in the abdominal cavity (simple free fluid was seen as anechoic regions surrounding intraperitoneal structures, while complex free fluid was seen as echogenic, with possible loculations); and (7) bowel perfusion: increased perfusion with >9 dots of color Doppler signal per square centimeter (Alexander et al, 2021 ; Gao et al, 2021 ). The key AR features of NEC included PVG, pneumoperitoneum, bowel dilatation, and reduced inflation (van Druten et al, 2019 ).…”