Neonatologist performed point‐of‐care bowel ultrasound: Is the time right?

Priyadarshi, Archana; Rogerson, Sheryle; Hinder, Murray; Tracy, Mark

doi:10.1002/ajum.12114

Cited by 11 publications

(20 citation statements)

References 21 publications

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“…DS auscultation will have been a mainstream methodology for diagnosis of bowel condition in the foreseen future. Although point-of-care ultrasound can provide more detailed information on bowel peristalsis, bowel wall thickness and bowel vascularity [40], it can be only performed by medical professionals within hospital settings. By contrast, DS auscultation is much more convenient without imposing constraints on professional knowledge and geographical locations.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Bowel Sound Detection Using Convolutional Neural Network and Laplace Hidden Semi-Markov Model

Sitaula,

He,

Priyadarshi

et al. 2021

Preprint

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Abdominal auscultation is a convenient, safe and inexpensive method to assess bowel conditions, which is essential in neonatal care. It helps early detection of neonatal bowel dysfunctions and allows timely intervention. This paper presents a neonatal bowel sound detection method to assist the auscultation. Specifically, a Convolutional Neural Network (CNN) is proposed to classify peristalsis and non-peristalsis sounds. The classification is then optimized using a Laplace Hidden Semi-Markov Model (HSMM). The proposed method is validated on abdominal sounds from 49 newborn infants admitted to our tertiary Neonatal Intensive Care Unit (NICU). The results show that the method can effectively detect bowel sounds with accuracy and area under curve (AUC) score being 89.81% and 83.96% respectively, outperforming 13 baseline methods. Furthermore, the proposed Laplace HSMM refinement strategy is proven capable to enhance other bowel sound detection models. The outcomes of this work have the potential to facilitate future telehealth applications for neonatal care. The source code of our work can be found at: https://bitbucket.org/chirudeakin/ neonatal-bowel-sound-classification/.

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Section: Discussionmentioning

confidence: 99%

Neonatal Bowel Sound Detection Using Convolutional Neural Network and Laplace Hidden Semi-Markov Model

Sitaula,

He,

Priyadarshi

et al. 2021

Preprint

Self Cite

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“…Detection of standard "gut signature", peristalsis and normal vascularity are a sign of a healthy bowel and reassuring to the clinician. Point-of-care abdominal US in the diagnosis of NEC has shown a definitive utility in the hands of pediatric radiologists [14,15]. Our group is exploring the utility of neonatologist performed point-of-care abdominal US to exclude NEC from CPAP belly syndrome, and determine the real negative and positive predictive value of its utility.…”

Section: Diagnosis Of Cpap Belly Syndromementioning

confidence: 99%

Continuous Positive Airway Pressure Belly Syndrome: Challenges of a Changing Paradigm

et al. 2020

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In extreme preterm infants, early use of continuous positive airway pressure (CPAP) for respiratory support reduces the incidence of chronic lung disease. However, as a sequel, inadvertent passage of air into the gastrointestinal tract leads to abdominal distension often with visibly dilated loops. The first description of "CPAP belly syndrome" in 1992, originates from the study in premature infants weighing less than 1,000 g and managed on nasal CPAP. The description of this phenomenon included benign episodic abdominal distension, with no associations to feed intolerance, and no radiological evidence of bowel wall thickening, pneumatosis or free air. With improving perinatal care, lesser gestational age infants are increasingly managed on early CPAP with resultant more frequent occurrence of CPAP belly syndrome. When extreme preterm infants on CPAP develop tense, marked abdominal distension, clinical decisions to cease feeds, administer empiric antibiotics and perform plain abdominal radiographs are all justified to screen for potentially serious causes. With rampant use of non-invasive respiratory support in extreme preterm infants, the occurrence of severe CPAP belly syndrome now extends to include clinical scenario mimicking a "necrotizing enterocolitis (NEC) scare". We present the case of an extreme preterm infant with severe CPAP belly syndrome that required rescue intubation due to a massively distended abdomen. The emergency management included change to invasive ventilation and exclusion of serious intestinal conditions such as NEC. In retrospect, the life-threatening marked abdominal distension was due to severe CPAP belly syndrome, contrary to its well-recognized benign description, three decades ago. The clinical paradigm of CPAP belly syndrome is evolving, and in its severe form in extreme preterm infants, warrants vigilant monitoring to differentiate it from severe progressive intestinal conditions, such as NEC. Further research is required to describe its causes, associated morbidities and the need to evaluate the utility of other diagnostic modalities to reassure clinicians.

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“…22,23 Non-contracting bowel wall thickness varies by age but normally ranges between 1 and 2.6 mm. 23 Pathologically thickened bowels can show increased echogenicity and alteration of the normal layered 'gut signature'. Pathologically thinned bowel could reflect ischaemia or necrosis.…”

Section: Introductionmentioning

confidence: 99%

“…23 Peristalsis is subjectively appreciable but could also be measured in a region of interest as movements per minute, with 10 or more considered normal. 23 Lastly, colour Doppler evaluation of mural blood flow is possible but is best characterised for NEC. Faingold et al 24 identified hyperaemia in early NEC with inflammation and an absence of Doppler signal in transmural ischaemia.…”

Section: Introductionmentioning

confidence: 99%

“…While the adult bowel is described as having five alternating hyper‐ and hypoechoic layers in a sonographic ‘gut signature’, there are typically only three layers visible in the neonate. The hypoechoic muscularis propria is the most prominent 22,23 . Non‐contracting bowel wall thickness varies by age but normally ranges between 1 and 2.6 mm 23 .…”

Section: Introductionmentioning

confidence: 99%

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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

Kimble,

Perry,

Bach

2024

J Med Imag Rad Onc

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IntroductionFortified 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‐emergent 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‐ and post‐fortifier inclusion.MethodsTen neonates of <32 weeks' gestation or a birth weight of <1,800 g recruited from Auckland City Hospital Neonatal Intensive Care between 1/5/2019 and 10/9/2019 received bowel ultrasounds within 24 h before and 10–14 days after starting FEBM. Bowel contents in six abdominal regions were assigned scores of 1–6 based on increasing solidification.ResultsLower gestational age was correlated with more solid contents on the pre‐fortifier ultrasound (P = 0.02). Fortifier was significantly associated with increasing solidity, particularly in the left abdomen (P < 0.001). The left lower quadrant and rectum accounted for much of this change (P = 0.012 and P = 0.002). One subject who subsequently developed a clinical picture consistent with early MCO had uniquely demonstrated non‐rectal solid contents (score 6). The interobserver kappa score for two assessors was 0.91 (95% CI 0.94–0.99) on still images.ConclusionThis small cohort demonstrated increasing bowel content solidification after breast milk fortification using a novel ultrasound scoring system with good interobserver agreement. Non‐rectal solid contents (score 6) appeared atypical. Ultrasound shows promise for its non‐irradiating diagnostic utility in the setting of early milk curd disease evaluation of the premature neonate.

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Neonatologist performed point‐of‐care bowel ultrasound: Is the time right?

Cited by 11 publications

References 21 publications

Neonatal Bowel Sound Detection Using Convolutional Neural Network and Laplace Hidden Semi-Markov Model

Neonatal Bowel Sound Detection Using Convolutional Neural Network and Laplace Hidden Semi-Markov Model

Continuous Positive Airway Pressure Belly Syndrome: Challenges of a Changing Paradigm

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

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