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Ultrasound for necrotizing enterocolitis: how can we optimize imaging and what are the most critical findings?

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Abstract

Necrotizing enterocolitis (NEC) is a common condition in the neonatal intensive care unit that continues to present challenges in terms of diagnosis and management. Traditionally NEC has been diagnosed and managed by clinical and radiographic findings, but US has shown promise in characterizing and prognosticating NEC. In this manuscript we review the abdominal US technique for NEC, the clinical significance of individual sonographic findings of NEC, and how US can be integrated in the clinical decision process for diagnosing and managing NEC. We also discuss the potential value-added role of a limited abdominal US protocol that focuses on the sonographic findings most indicative of a poor prognosis to include pneumoperitoneum, complex free fluid and focal fluid collections.

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Authors and Affiliations

  1. Department of Radiology, Nemours Children’s Health/Nemours Children’s Hospital Delaware, Wilmington, DE, USA

    Lauren A. May

  2. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Lauren A. May

  3. Department of Radiology, Nemours Children’s Health/Nemours Children’s Hospital, Orlando, FL, USA

    Monica Epelman

  4. University of Central Florida, Orlando, FL, USA

    Monica Epelman

  5. Department of Radiology, Nicklaus Children’s Hospital, 3100 SW 62 Ave., Miami, FL, 33155, USA

    Monica Epelman

  6. Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada

    Alan Daneman

Authors
  1. Lauren A. May
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  2. Monica Epelman
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  3. Alan Daneman
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Correspondence to Monica Epelman.

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Online Supplementary Material 1 Videoclip of a 30-day-old boy born at 30 weeks of gestation with a history of trisomy 21 and necrotizing enterocolitis at 7 days of age, when he was transferred to our institution with signs of infection/presumed sepsis and cholestasis (same boy as in Fig. 1). Videoclip of the US exam in transverse orientation shows punctate foci of gas within the portal vein and hepatic parenchyma, consistent with portal venous gas (MP4 1980 KB)

Online Supplementary Material 2 Videoclip of a 27-day-old boy born at 22 weeks of gestation with a birth weight less than 600 g. He presented with abdominal distension and sepsis at 4 weeks of age. Videoclip of the US exam in transverse orientation shows a featureless, markedly distended aperistaltic bowel loop with pneumatosis (same boy as in Fig. 3). This was consistent with a necrotic loop of bowel and a contained perforation, which were found at bedside laparotomy (MP4 2436 KB)

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May, L.A., Epelman, M. & Daneman, A. Ultrasound for necrotizing enterocolitis: how can we optimize imaging and what are the most critical findings?. Pediatr Radiol 53, 1237–1247 (2023). https://doi.org/10.1007/s00247-022-05545-x

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  • DOI: https://doi.org/10.1007/s00247-022-05545-x

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