Abdominal Ultrasound Scanning for NEC in Babies at the Threshold of Viability
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New article you should know about by Kim Priban RN, selected by @jpedsurg
Made possible by @cincychildrens
"Abdominal Ultrasound Scanning for NEC in Babies at the Threshold of Viability- A Single Centre Experience”
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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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What do you think the optimal diagnostic radiological approach is for a neonatal baby where necrotizing enterocolitis is suspected? Hi, this is Kim Priven, a research fellow at Cincinnati Children's, and I'm excited to share this article that we think you should know about. This study was a single site retrospective cohort study of 39 babies who were born under 24 weeks gestation and were diagnosed with some degree. of necrotizing enterocolitis. Because neonatal babies can present atypically, clinically and radiologically, the best diagnostic tool to predict the need for surgery hasn't really been determined yet. This study then looked at the accuracy of abdominal ultrasound scans in 17 patients where radiography wasn't definitive regarding the management of these patients. And what did they find? 12 of the 17 patients. We recommended for surgery and 5 for medical management, and when they evaluated the outcomes, they found that 100% of the time, the ultrasound correctly predicted the need for surgery, and there was no mortality in the non-surgical patients. While more studies are needed, abdominal ultrasounds really look to be more helpful to help determine if surgery is needed. Thanks for watching, like and share, and check back often for more articles we think you should know about.