Original ArticlePrognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age☆
Section snippets
Patients and methods
This was a single-center, retrospective study conducted in a Level 3 university maternity unit.
Description of the study population
In total, 442 premature infants of less than 33 weeks gestational age were born between January 1, 2009 and November 30, 2011, of whom 123 (27.8%) presented with NEC symptoms (Fig. 1).
For the 28 infants excluded from analysis, intrauterine growth retardation was more common (46.4% vs. 20.7%, p = 0.007) and birth weight lower (1037 ± 299 vs. 1175 ± 309, p = 0.038) than for the 95 infants included in the analysis. As to NEC stages, they were less than or equal to stage 1B of Bell’s classification. All of
Discussion
NEC is a common complication of prematurity, as nearly 90% of cases involve preterm infants (< 37 weeks gestational age). NEC’s incidence and the associated morbidity and mortality remain unchanged over time due to the birth of increasingly immature infants. In our NICU, the rate of Stage ≥ 2 NEC [5] in infants of less than 33 weeks gestational age (7.4%) was similar to the data reported in the literature [2], [25].
The usefulness of ultrasonography in NEC diagnosis has been known since 1984 [12].
Conclusion
Ultrasonography is a useful tool for assessing the prognosis of NEC in preterm infants and allows for detecting signs predictive of adverse outcome. Sonographic intramural gas at the time of the acute episode was associated with a high risk of stenosis. Furthermore, abdominal fluid or free air, portal venous gas, and parietal thickening detected on abdominal ultrasound were also associated with an adverse evolution (surgery and/or death). Physicians should consider the use of abdominal
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Role of Abdominal US in Diagnosis of NEC
2019, Clinics in PerinatologyCitation Excerpt :Measures of resistive index or pulsatility index also may be helpful with the diagnosis of NEC.20 Several studies have shown that BUS is helpful in evaluating the viability of bowel in preterm infants suspected of having NEC.21–32 In these studies, the gray-scale characteristics of bowel can be detailed.
Surgical considerations for neonates with necrotizing enterocolitis
2018, Seminars in Fetal and Neonatal MedicineCitation Excerpt :Whereas plain film radiographs remain the reference standard imaging modality for the diagnosis of NEC, ultrasonography has played an increasing role in evaluation of the disease. In the early stages of NEC, plain radiographs may only show nonspecific dilated loops of bowel; however, ultrasonography has been shown to identify bowel wall thickening, decreased perfusion of the bowel wall, portal venous gas, and pneumatosis intestinalis noted by the presence of hyperechoic spots representing “air microbubbles” within the bowel wall that may not be appreciable on radiography [9,12,13]. A recent meta-analysis comprising 11 studies and 748 infants showed that focal fluid collections, complex ascites, bowel wall thinning, absence of perfusion, bowel wall thickening, and pneumoperitoneum, when seen on ultrasonography, had a significant association with both surgical intervention and mortality [14].
Necrotizing Enterocolitis and Short Bowel Syndrome
2018, Avery's Diseases of the Newborn: Tenth EditionNecrotizing Enterocolitis and Short Bowel Syndrome
2017, Avery's Diseases of the Newborn, Tenth EditionFeasibility and acceptability of a diagnostic randomized clinical trial of bowel ultrasound in infants with suspected necrotizing enterocolitis
2022, European Journal of Pediatrics
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Conflict of interest: We have no conflict of interest in relation to this study.