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A new intestinal ultrasound integrated approach for the management of neonatal gut injury

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Abstract

Clinical management of gut injury has been a challenge to the clinician since the first description of necrotizing enterocolitis (NEC) about 50 years ago, and it is still poorly defined. Most of the diagnostic markers are non-specific, and there is no consensus yet on a reliable gold standard for diagnosis. This report describes our approach to integrating point of care intestinal ultrasound (IUS) as the primary radiological assessment modality with other clinical and biochemical markers.

Conclusions: This is the first clinical guideline integrating point of care IUS as a routine assessment of the gut injury. This integrated algorithm improves the quality of care of the gut injury, provides a more accurate diagnosis of NEC, and differentiates other categories of gut injury.

What is Known:

• Necrotizing enterocolitis is a poorly defined disease, and the routine assessment relying on AXR does not differentiate NEC from other categories of gut injury.

What is New:

• Integrating point of care IUS with the routine clinical assessment of gut injury enables the gut injury to be classified according to the triggering factors and severity; this helps target the appropriate management.

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Abbreviations

AXR:

Abdominal x-ray

CRP:

C-reactive protein

FPIE:

Food protein-induced enterocolitis

HIEc:

Hypoxic ischemic enterocolopathy

IUS:

Intestinal ultrasound

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

NIRS:

Near infrared spectroscopy

NPO:

Nil per os

PI:

Pneumatosis intestinalis

PVG:

Portal venous gas

POCUS:

Point of care ultrasound

SIP:

Spontaneous intestinal perforation

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Authors and Affiliations

  1. Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada

    Yasser Elsayed & Mary Seshia

Authors
  1. Yasser Elsayed
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  2. Mary Seshia
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Contributions

YE and MS conceptualized the article. YE and MS conducted the background literature search. YE devised the manuscript, and both authors agree to the formatting and contents.

Corresponding author

Correspondence to Yasser Elsayed.

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The authors declare no competing interests.

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Communicated by Daniele De Luca

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Elsayed, Y., Seshia, M. A new intestinal ultrasound integrated approach for the management of neonatal gut injury. Eur J Pediatr 181, 1739–1749 (2022). https://doi.org/10.1007/s00431-021-04353-z

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  • DOI: https://doi.org/10.1007/s00431-021-04353-z

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