Abdominal Ultrasound Scanning for NEC in Babies at the Threshold of Viability

Infographic · May 2024 · 1 min read

In brief

Study evaluating abdominal ultrasound (AUSS) for diagnosing necrotizing enterocolitis in extremely premature infants born <24 weeks gestation. AUSS findings (complex ascites, inflamed bowel, aperistaltic bowel) reliably identified surgical candidates, outperforming plain radiography in this vulnerable population.

Abdominal ultrasound reliably identifies surgical NEC in extremely preterm infants (<24 weeks) with atypical presentations.
Complex ascites, inflamed/aperistaltic bowel, and masses on ultrasound correlated with surgical NEC in all 12 operative cases.
Plain radiographs often show only nonspecific findings (paucity of gas) in this population, limiting diagnostic utility.
Simple free fluid or isolated pneumatosis on ultrasound may indicate non-operative NEC amenable to medical management.
Ultrasound adds critical diagnostic value when clinical and radiographic findings are equivocal in threshold-viability infants.

Written by the GCMD Library team from the infographic.

A teal and yellow infographic divided into sections with icons including a calendar, fetus, ultrasound probe, footprints, and intestines. The layout presents study methodology at top, numerical results in center with large yellow numbers, and conclusion at bottom. Color-coded arrows (yellow, black, red, teal) highlight key findings.

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"Abdominal Ultrasound Scanning for NEC in Babies at the Threshold of Viability- A Single Centre Experience”

Full article:

https://gcmd.co/4bob7uG

Authors: Natalie Vallant, Hemanshoo Thakkar, Haran Jogeesvaran, Iain Yardley

Aim

Neonatal units are caring for increasing numbers of babies born <24 weeks gestation. These babies are vulnerable to developing necrotising enterocolitis (NEC). Their presentation is often atypical, both clinically and radiologically. Optimal diagnostic strategies are not yet known. We report our experience of abdominal ultrasound scanning (AUSS) to clarify its role.

Methods

All babies in a single neonatal surgical centre born <24 weeks gestation undergoing AUSS for suspected NEC from January 2015 to January 2023 were included. We compared abdominal ultrasound findings with plain radiographs and correlated these to intraoperative findings.

Results

Thirty-nine babies born <24 weeks gestation were diagnosed with NEC during the study period, and of these seventeen had an AUSS and formed the study cohort. Twelve underwent laparotomy at which NEC was confirmed, and the remaining five were managed non-operatively.

Abdominal radiograph findings were: Paucity of gas (12), gaseous dilatation (2), paucity of gas with proximal dilatation (1), pneumatosis (1), and lucencies over the liver (1). In twelve cases who underwent surgery, AUSS findings were (more than one possible): Complex ascites (6), inflamed bowel (4), aperistaltic bowel (3), mass/collection (4), pneumatosis (1). All had NEC confirmed at laparotomy. In five cases who did not progress to surgery, findings were: Simple free fluid (2), pneumatosis (2), inflamed bowel (1), aperistaltic bowel (1). None of these cases subsequently underwent surgery or died of complications of NEC.

Conclusion

AUSS is a useful imaging modality for NEC in babies born <24 weeks gestation. It can reliably identify babies who would benefit from surgery.

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