Advantages of Abdominal Ultrasound in the Management of Infants with Necrotizing Enterocolitis

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2016 Nov 9

PMID 27822782

Citations 13

Authors

M M Aliev

A A Dekhqonboev

R Z Yuldashev

Affiliations

Soon will be listed here.

Abstract

Methods: Fifty-one consecutive infants with stage Ia to IIIa NEC were prospectively included in the study between 2013 and July 2016. At least one abdominal US examination was performed in each patient.

Results: According to abdominal color Doppler US, neonates with NEC Ia stage in most cases (80%) found increased bowel wall perfusion. For the stage IIa typical signs were intramural gas and decreased bowel peristalsis. Patients in IIb stage had bowel wall thinning (less than 1 mm), decreased or absence of bowel peristalsis and absence of perfusion. In stage IIIa 71% of the cases had absence of bowel peristalsis and intramural gas. Absence of perfusion and bowel wall thinning less than 1 mm was found in 86% of neonates. One patient had portal venous gas. Nine patients with IIb and seven neonates with IIIa stage of NEC had laparotomy. In all 16 cases, US signs of bowel wall necrosis were verified intraoperative.

Conclusion: US provides an opportunity to image the bowel loops in cross section with dynamic evaluation of perfusion and peristalsis. Our study shows that abdominal US examination in neonates with NEC can highlight the presence of intestinal necrosis before the onset of intestinal perforation. Surgically intervening earlier in the clinical pathway of NEC may lead to improved outcomes.

Citing Articles

Methods of identifying surgical Necrotizing Enterocolitis-a systematic review and meta-analysis.

Bethell G, Jones I, Battersby C, Knight M, Hall N Pediatr Res. 2024; 97(1):45-55.

PMID: 38849483 PMC: 11798840. DOI: 10.1038/s41390-024-03292-3.

Application of abdominal ultrasonography in surgical necrotizing enterocolitis: a retrospective study.

Chen Q, Yao W, Xu F, Liao J, Li J, Mai M Front Microbiol. 2023; 14:1211846.

PMID: 37346747 PMC: 10281645. DOI: 10.3389/fmicb.2023.1211846.

Value of abdominal ultrasonography in predicting intestinal resection for premature infants with necrotizing enterocolitis.

Chen J, Mu F, Gao K, Yan C, Chen G, Guo C BMC Gastroenterol. 2022; 22(1):524.

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Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis.

Gao H, Yi B, Mao B, Li W, Bai X, Zhang Y Clinics (Sao Paulo). 2021; 76:e1816.

PMID: 33787653 PMC: 7978842. DOI: 10.6061/clinics/2021/e1816.

Doppler ultrasound assessment of splanchnic perfusion and heart rate for the detection of necrotizing enterocolitis.

Ganji N, Koike Y, Li B, Zhu H, Lau E, Janssen Lok M Pediatr Surg Int. 2021; 37(3):347-352.

PMID: 33580271 DOI: 10.1007/s00383-020-04819-5.

References

Holman R, Stoll B, Clarke M, Glass R . The epidemiology of necrotizing enterocolitis infant mortality in the United States. Am J Public Health. 1998; 87(12):2026-31. PMC: 1381250. DOI: 10.2105/ajph.87.12.2026. View

Neu J, Walker W . Necrotizing enterocolitis. N Engl J Med. 2011; 364(3):255-64. PMC: 3628622. DOI: 10.1056/NEJMra1005408. View

Silva C, Daneman A, Navarro O, Moore A, Moineddin R, Gerstle J . Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol. 2007; 37(3):274-82. DOI: 10.1007/s00247-006-0393-x. View

Braccini G, Lamacchia M, Boraschi P, BERTELLOTTI L, Marrucci A, Goletti O . Ultrasound versus plain film in the detection of pneumoperitoneum. Abdom Imaging. 1996; 21(5):404-12. DOI: 10.1007/s002619900092. View

Kim W, Kim I, Kim W, Yeon K, Kim G, Lee S . Sonographic findings in a model of ischemia-induced necrotizing enterocolitis with pathological correlations. Invest Radiol. 2007; 42(5):312-8. DOI: 10.1097/01.rli.0000258681.14275.19. View

Guthrie S, Gordon P, Thomas V, Thorp J, Peabody J, Clark R . Necrotizing enterocolitis among neonates in the United States. J Perinatol. 2003; 23(4):278-85. DOI: 10.1038/sj.jp.7210892. View

Yikilmaz A, Hall N, Daneman A, Gerstle J, Navarro O, Moineddin R . Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis. Pediatr Surg Int. 2014; 30(12):1231-40. DOI: 10.1007/s00383-014-3613-8. View

Stoll B, Hansen N, Bell E, Shankaran S, Laptook A, Walsh M . Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010; 126(3):443-56. PMC: 2982806. DOI: 10.1542/peds.2009-2959. View

Kasivajjula H, Maheshwari A . Pathophysiology and current management of necrotizing enterocolitis. Indian J Pediatr. 2014; 81(5):489-97. DOI: 10.1007/s12098-014-1388-5. View

10.

Llanos A, Moss M, Pinzon M, Dye T, Sinkin R, Kendig J . Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinat Epidemiol. 2002; 16(4):342-9. DOI: 10.1046/j.1365-3016.2002.00445.x. View

11.

Dilli D, Suna Oguz S, Erol R, Ozkan-Ulu H, Dumanli H, Dilmen U . Does abdominal sonography provide additional information over abdominal plain radiography for diagnosis of necrotizing enterocolitis in neonates?. Pediatr Surg Int. 2010; 27(3):321-7. DOI: 10.1007/s00383-010-2737-8. View

12.

Kim W, Kim W, Kim I, Kwon T, Chang W, Lee E . Sonographic evaluation of neonates with early-stage necrotizing enterocolitis. Pediatr Radiol. 2005; 35(11):1056-61. DOI: 10.1007/s00247-005-1533-4. View

13.

Bohnhorst B . Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed. 2013; 98(5):F445-50. DOI: 10.1136/archdischild-2012-302848. View

14.

Faingold R, Daneman A, Tomlinson G, Babyn P, Manson D, Mohanta A . Necrotizing enterocolitis: assessment of bowel viability with color doppler US. Radiology. 2005; 235(2):587-94. DOI: 10.1148/radiol.2352031718. View

15.

Muchantef K, Epelman M, Darge K, Kirpalani H, Laje P, Anupindi S . Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatr Radiol. 2013; 43(11):1444-52. DOI: 10.1007/s00247-013-2725-y. View

16.

Epelman M, Daneman A, Navarro O, Morag I, Moore A, Kim J . Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics. 2007; 27(2):285-305. DOI: 10.1148/rg.272055098. View

17.

Silva C, Daneman A, Navarro O, Moineddin R, Levine D, Moore A . A prospective comparison of intestinal sonography and abdominal radiographs in a neonatal intensive care unit. Pediatr Radiol. 2013; 43(11):1453-63. DOI: 10.1007/s00247-013-2777-z. View

18.

Walsh M, Kliegman R . Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986; 33(1):179-201. PMC: 7131118. DOI: 10.1016/s0031-3955(16)34975-6. View

19.

Luig M, Lui K . Epidemiology of necrotizing enterocolitis--Part II: Risks and susceptibility of premature infants during the surfactant era: a regional study. J Paediatr Child Health. 2005; 41(4):174-9. DOI: 10.1111/j.1440-1754.2005.00583.x. View

20.

Horbar J, Badger G, Carpenter J, Fanaroff A, Kilpatrick S, LaCorte M . Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics. 2002; 110(1 Pt 1):143-51. DOI: 10.1542/peds.110.1.143. View