Advantages of abdominal ultrasound in the management of infants with necrotizing enterocolitis.

The purpose of this study was to assess the prognostic value of abdominal color Doppler ultrasound (US) in determining predictors of early complications of NEC.

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.