Availability, utilization, and barriers to bowel ultrasound for necrotizing enterocolitis...

Dr. Lizzy Lee from Cincinnati Children's discusses a national multidisciplinary survey on the availability and use of bowel ultrasound (BUS) for diagnosing necrotizing enterocolitis (NEC). The study found that while BUS is available in many Level 4 NICUs, routine utilization is inconsistent due to barriers like lack of standardized protocols, limited provider training, and uncertainty in guiding treatment decisions. This article highlights the need for better evidence, standardized guidelines, and improved clinician training to enhance BUS adoption for NEC. Alain Cuna, Julie D Thai, Kera McNelis, Loren Berman, Katie Huff, Sujir Pritha Nayak, Amy E O'Connell, Catherine J Hunter, Hala Chaaban, Eshanika Manchanda, Amina M Bhatia, Kate Louise M Mangona, Leeann Pavlek, Parvesh Garg, Lauren C Frazer, Mohan Pammi, Catalina Le Cacheux, Bhuvaneshwari Jagadesan, Toby D Yanowitz, Irfan Ahmad, Muralidhar H Premkumar Objective: To characterize availability, utilization, and barriers to bowel ultrasound (BUS) for necrotizing enterocolitis (NEC). Methods: A survey of neonatologists, surgeons, and radiologists at Children's Hospitals' Neonatal Consortium (CHNC) sites. Quantitative data were analyzed descriptively; open-ended responses underwent thematic analysis. Results: In total, 104 respondents from 42/46 institutions participated. BUS was available at 83% of level IV NICU sites, with 64% reporting 24/7 availability. However, only 42% of affiliated level III NICUs had BUS available. BUS was primarily used alongside radiographs in cases of diagnostic uncertainty and variably used to guide surgical decisions. Radiologists frequently used protocols while neonatologists and surgeons reported limited training and few institutional guidelines. Key barriers included lack of standardization, inadequate training, and unclear clinical utility. Conclusion: BUS is increasingly available in level IV NICUs but less so in level III NICUs. Even when available, clinical integration is inconsistent due to gaps in standardization, training, and supporting evidence.