A role for abdominal ultrasound in discriminating suspected necrotizing enterocolitis in congenital heart disease patients
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In brief
In brief
Study comparing 86 neonates with suspected NEC found that congenital heart disease patients present with distinct clinical features and less frequent ultrasound findings of pneumatosis compared to non-CHD patients. Abdominal ultrasound proved particularly valuable in CHD patients for assessing bowel viability, with discordant AXR findings occurring 3.9-fold more often in this population.
Written by the GCMD Library team from the article.
Abstract
Purpose
We evaluated the diagnostic utility of abdominal ultrasound (AUS), an adjunct to abdominal X-ray (AXR), for necrotizing enterocolitis (NEC) in congenital heart disease (CHD) patients.
Methods
86 patients with suspected NEC from 2009 to 2018 were classified as with CHD (n = 18) if they required cardiac intervention versus without CHD (n = 68). Clinical and radiological data were collected, including AXR and AUS concordance. Wilcoxon rank-sum test and Fisher’s exact test were performed.
Results
CHD patients had higher birth weights (p < 0.001) and gestational ages (p < 0.001) than non-CHD patients. CHD patients presented more frequently with hypotension (p = 0.041) and less frequently with bilious emesis (p < 0.001). Overall, CHD patients were less likely to have AUS findings of pneumatosis (33.3 vs. 72.1%; p = 0.005) and decreased mural flow (0 vs. 20.6%; p = 0.035) compared to non-CHD patients. On concordance analysis, CHD patients had 3.9-fold more discordant studies with pneumatosis on AXR but not on AUS (33.3 vs. 8.8%; p = 0.016) compared to non-CHD patients. Urgent surgery was required in 5.6% of CHD patients versus 16.2% of non-CHD patients.
Conclusion
CHD patients with suspected NEC represent a distinct clinical population. AUS has particular utility in assessing findings of bowel viability in the CHD NEC population, reflecting reduced rates of surgical NEC.