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Abdominal ultrasound should become part of standard care for early diagnosis and management of necrotising enterocolitis: a narrative review
  1. Jacqueline van Druten1,
  2. Minesh Khashu2,3,
  3. Sherwin S Chan4,
  4. Saeed Sharif1,
  5. Hassan Abdalla1
  1. 1 School of Architecture Computing and Engineering, University of East London, London, Greater London, UK
  2. 2 Perinatal Health, Bournemouth University, Poole, Dorset, UK
  3. 3 Department of Neonatology, Poole Hospital NHS Foundation Trust, Poole, UK
  4. 4 Department of Radiology, Children’s Mercy Hospitals and Clinics, Kansas City, Kansas, USA
  1. Correspondence to Mrs Jacqueline van Druten, University of East London School of Architecture Computing and Engineering, London E16 2RD, UK; Jacqueline.vandruten{at}


Necrotising enterocolitis (NEC) is a leading cause of death and disability in preterm newborns. Early diagnosis through non-invasive investigations is a crucial strategy that can significantly improve outcomes. Hence, this review gives particular attention to the emerging role of abdominal ultrasound (AUS) in the early diagnosis of NEC, its performance against abdominal radiograph and the benefits of AUS use in daily practice. AUS has been used in the diagnosis and management of NEC for a couple of decades. However, its first-line use has been minimal, despite growing evidence demonstrating AUS can be a critical tool in the early diagnosis and management of NEC. In 2018, the NEC group of the International Neonatal Consortium recommended using AUS to detect pneumatosis and/or portal air in preterm NEC as part of the ‘Two out of three’ model. To facilitate widespread adoption, and future improvement in practice and outcomes, collaboration between neonatologists, surgeons and radiologists is needed to generate standard operating procedures and indications for use for AUS. The pace and scale of the benefit generated by use of AUS can be amplified through use of computer-aided detection and artificial intelligence.

  • necrotising enterocolitis
  • abdominal radiograph
  • abdominal ultrasound
  • differential diagnosis
  • big data
  • artificial intelligence
  • acquired neonatal intestinal disease
  • spontaneous intestinal perfusion
  • real world evidence
  • machiene learning
  • standard operating procedures
  • point of care
  • diagnostics

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  • Contributors JvD: main literature search, evidence acquisition, writing of first draft, design of figures and formatting. MK: clinical insights, current NEC research insights, review of article, writing, review and formatting. SSC: clinical insight, acquisition of radiology images for table 2, additional evidence acquisition and current neonatal radiology research insights. SS: project supervisor, review article, AI insight and CAD technology insight. HA: research methodology and review of manuscript.

  • Funding JvD was awarded an educational grant by NEC UK ( that partially supported her PhD research, 2018–2019.

  • Competing interests SSC reports grants and other from Jazz Pharmaceuticals, outside the submitted work. JvD received a consultation fee from Danone to independently compile a report and present at a stakeholder meeting.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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