Abdominal ultrasound should become part of standard care for early diagnosis and management of necrotising enterocolitis: a narrative review

Abstract

Necrotising enterocolitis (NEC) is a leading cause of death and disability in preterm newborns. Early diagnosis through non-invasive investigations is a crucial strategy that can significantly improve outcomes. Hence, this review gives particular attention to the emerging role of abdominal ultrasound (AUS) in the early diagnosis of NEC, its performance against abdominal radiograph and the benefits of AUS use in daily practice. AUS has been used in the diagnosis and management of NEC for a couple of decades. However, its first-line use has been minimal, despite growing evidence demonstrating AUS can be a critical tool in the early diagnosis and management of NEC. In 2018, the NEC group of the International Neonatal Consortium recommended using AUS to detect pneumatosis and/or portal air in preterm NEC as part of the ‘Two out of three’ model. To facilitate widespread adoption, and future improvement in practice and outcomes, collaboration between neonatologists, surgeons and radiologists is needed to generate standard operating procedures and indications for use for AUS. The pace and scale of the benefit generated by use of AUS can be amplified through use of computer-aided detection and artificial intelligence.

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

“…Similarly, US outperforms abdominal X-ray plain film in the detection rates of PVG, dilatation of the intestine (27,28), intramural air, and so on. In 2018, a meta-analysis by Chan et al systematically reviewed the works about the diagnostic accuracy of US in the diagnosis of NEC (29). They discovered that individual signs of NEC (PVG, pneumatosis, free air, bowel wall thinning, absent peristalsis, and abdominal fluid) had overall low sensitivities and high specificities.…”

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

“…POCUS can provide prognostic value identifying free fluid, bowel wall thickness, pneumatosis intestinalis, portal venous gas and vascular perfusion [159,[163][164][165][166]. The International Neonatal Consortium's NEC subgroup recently revisited the necrotizing enterocolitis (NEC) pathogenesis and new diagnostic criteria were proposed [167]. These were based on the so-called 'two out of three' model which includes pneumatosis intestinalis or portal venous gas by abdominal X-rays and/or POCUS.…”

A Deep Learning Based Suggested Model to Detect Necrotising Enterocolitis in Abdominal Radiography Images

“…Neonatology and paediatrics lack computer-aided detection software (CAD) for neonatal imaging that can help screening, detection and ensuring standardised reporting of imaging findings [36], [37]. Furthermore, novel imaging modalities like AUS remains underutilised due to the lack of expertise in its use and reporting [36], [37]. Highlighting a further area for CAM to assist the integration of new point of care ultrasound (POCUS) to overcome underutilisation [26], [36], [37].…”

“…Furthermore, novel imaging modalities like AUS remains underutilised due to the lack of expertise in its use and reporting [36], [37]. Highlighting a further area for CAM to assist the integration of new point of care ultrasound (POCUS) to overcome underutilisation [26], [36], [37].…”