Efficacy of bowel ultrasound to diagnose necrotizing enterocolitis in extremely low birthweight infants

Article type: Research Article

Authors: Ionov, O.V.^{a; b; c} | Sharafutdinova, D.R.^{a; b; *} | Sugak, A.B.^a | Filippova, E.A.^{a; d} | Balashova, E.N.^a | Kirtbaya, A.R.^{a; b} | Karasova, L.Kh.^a | Dorofeeva, E.I.^a | Podurovskaya, Y.L.^a | Yarotskaya, E.L.^a | Zubkov, V.V.^{a; b} | Degtyarev, D.N.^{a; b} | Donn, S.M.^e

Affiliations: [a] National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russia | [b] Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), Moscow, Russia | [c] GBUZ MO “Research Clinical Institute of Childhood Ministry of Health of the Moscow Region”, Moscow, Russia | [d] Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation, Moscow, Russia | [e] Division of Neonatal–Perinatal Medicine, Department of Pediatrics, C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

Correspondence: [*] Address for correspondence: D.R. Sharafutdinova, Russia, 119435, Moscow, Bolshaya Pirogovskaya st., 2, Build. 4. Tel.: +7 495 438 22 77; E-mail: dikarush@gmail.com.

Abstract: BACKGROUND:Bowel ultrasound (US) is one of the methods used to enhance diagnostic accuracy of necrotizing enterocolitis (NEC) and its associated complications in premature newborns. AIM:To explore the diagnostic accuracy of bowel US in extremely low birth weight (ELBW) infants with NEC. METHODS:A single-center retrospective case-control study included 84 extremely low birth weight (ELBW) infants. The infants were divided into three groups: Group 1 –infants with NEC (n = 26); Group 2 –infants with feeding problems (n = 28); Group 3 –control group (n = 30). RESULTS:The specific bowel US findings in premature newborns with NEC (stage 3) included bowel wall thinning, complex (echogenic) ascites, and pneumoperitoneum, p < 0.05. The diagnostic effectiveness of these sonographic signs was 96.8% (sensitivity 75.0% and specificity 97.6%), p < 0.05. These findings with high specificity were associated with the need for surgical intervention, poor outcomes, or increased mortality. Stage 2 NEC which did not require surgery showed impaired differentiation of the bowel wall layers, absent or decreased bowel peristalsis, pneumatosis intestinalis, portal venous gas, or simple ascites, with a diagnostic accuracy of 82.9% (sensitivity 55.6%, specificity 91.4%, p < 0.05). CONCLUSIONS:Bowel US can be used as an adjunct to abdominal radiography to aid in the diagnosis of infants with suspected NEC by providing more detailed evaluation of the intestine.

Keywords: Bowel ultrasound, extremely low birth weight, intestine, necrotizing enterocolitis, premature newborns

DOI: 10.3233/NPM-230201

Journal: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 4, pp. 527-534, 2024