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The role of an abbreviated ultrasound in the evaluation of necrotizing enterocolitis

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Abstract

Background

Bowel ultrasound is a useful diagnostic tool in the diagnosis and management of necrotizing enterocolitis (NEC) but can be time-consuming and requires technical expertise, particularly for assessing pneumatosis. Previous literature on sonographic evaluation of NEC has focused on a full bowel ultrasound protocol, but the utility of an abbreviated protocol primarily aimed at identifying high-risk sonographic findings without focused bowel assessment has not been well studied.

Objective

This study aims to describe the diagnostic accuracy of an abbreviated ultrasound protocol for identifying high-risk NEC findings.

Materials and methods

This is a retrospective, institutional review board-approved study. We identified all abbreviated NEC ultrasounds performed between January 2014 and August 2022 at our institution. Exams were reviewed for the presence of high-risk findings including pneumoperitoneum, fluid collections, and complex free fluid. Clinical outcome was categorized as poor or good depending on if emergent surgical intervention or death related to NEC occurred. The frequency of follow-up NEC ultrasounds was reviewed to determine if new findings affected outcome. Sensitivity, specificity, and positive and negative predictive values were generated to assess the performance of the abbreviated ultrasounds to identify high-risk findings.

Results

A total of 84 abbreviated abdominal ultrasounds were performed on 73 children. Median age at the time of ultrasound was 41 days (interquartile range (IQR) 53 days) and median gestational age was 35 weeks and 3 days (IQR 80 days), and 44/73 (60%) were male. Thirteen ultrasounds had at least one high-risk finding with nine (69%) resulting in a poor outcome, including seven surgical interventions and four deaths. Two patients had surgical intervention and died as a result of necrotizing enterocolitis. Ultrasounds without high-risk findings were not associated with poor clinical outcomes. Sensitivity, specificity, positive predictive value, and negative predictive value of the abbreviated NEC ultrasound were 100% (95% CI 60–100%), 95% (95% CI 86–98%), 69% (95% CI 39–90%), and 100% (95% CI 94–100%), respectively. Twelve abbreviated ultrasounds were followed by a second NEC ultrasound within 5 days. Five follow-up ultrasounds demonstrated new high- or low-risk findings, but the new findings did not correlate with a change in outcome as predicted by the initial ultrasound.

Conclusion

An abbreviated NEC ultrasound can be of clinical utility in predicting poor outcomes, particularly during non-business hours when resources are limited.

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Data availability

All data collected was anonymized and stored in a password-protected Excel spreadsheet to protect patient confidentiality and privacy. The datasets generated and/or analyzed during the current study are available upon reasonable request from the corresponding author.

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Funding

This work was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (Hicks).

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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 & Joanna Costa

  3. Department of Neonatology, Nemours Children’s Health, Nemours Children’s Hospital Delaware, Wilmington, DE, USA

    Joanna Costa

  4. Biostatistics Core, Nemours Biomedical Research, Nemours Children’s Health System, Wilmington, DE, USA

    Jobayer Hossain

  5. Department of Radiology, Nemours Children’s Health System, Florida, Orlando, FL, USA

    Monica Epelman

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

    Monica Epelman

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  1. Lauren A. May
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  2. Joanna Costa
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  3. Jobayer Hossain
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  4. Monica Epelman
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Contributions

LM, JC, and ME were involved in study concept, data analysis, drafting the manuscript, and performing revisions as requested by the journal. LM and JC performed data collection. JB was involved in study design, data analysis, manuscript creating, and manuscript revisions. All authors reviewed and approved the final manuscript.

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Correspondence to Lauren A. May.

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May, L.A., Costa, J., Hossain, J. et al. The role of an abbreviated ultrasound in the evaluation of necrotizing enterocolitis. Pediatr Radiol (2024). https://doi.org/10.1007/s00247-024-05912-w

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  • DOI: https://doi.org/10.1007/s00247-024-05912-w

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