Necrotizing enterocolitis symposium: Epidemiology and early diagnosis

Eaton, Simon

doi:10.1016/j.jpedsurg.2016.11.013

Cited by 23 publications

(24 citation statements)

References 28 publications

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“…It is important to draw parallels between timing of physiological progression and the accompanying findings on imaging to diagnose NEC early and monitor for the need for surgery (table 3 and figures 1–6). 34 48 49 51 PI and PVG remain the hallmarks of NEC on ARs 7 17 19 27 30. Bowel wall thickness, bowel wall texture, bowel necrosis53 and bowel peristalsis are all much more difficult to evaluate by AR compared with AUS 20 32 35 54.…”

Section: Differential Clinical and Imaging Findingsmentioning

confidence: 99%

“…Without validated serum biomarkers to differentiate or monitor ANIDs, imaging is often used to confirm NEC diagnosis and initiate treatment 1 5 6. Bedside imaging has the advantages of real-time feedback and a faster turnaround time compared with serum biomarkers, at least until a point-of-care serum biomarker test is identified and adopted 7. However, imaging is challenging because imaging equipment and protocols vary and there is high variability in interpretation and reporting 8.…”

Section: Introductionmentioning

confidence: 99%

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

Druten

Khashu

Chan

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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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.

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Section: Differential Clinical and Imaging Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Druten

Khashu

Chan

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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“…For those that require emergency surgery, 46,5% do not survive. 25% of those survivors develop life-altering co-morbidities such as short bowel syndrome or impaired neuro-development [2], [3]. Despite significant investment in time and resources, our understanding of the causation of NEC has not progressed enough to improve outcomes [4]- [7].…”

Section: Introductionmentioning

confidence: 99%

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

Druten

Sharif

Chan

et al. 2019

2019 International Conference on Computing, Electronics &Amp; Communications Engineering (iCCECE)

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Despite decades of exploration into necrotising enterocolitis (NEC), we still lack the capacity to accurately diagnose the disease to improve outcomes in its management. Existing diagnostics struggle to delineate NEC from other neonatal intestinal diseases; it is also unable to highlight those likely to deteriorate to needing emergency life-saving surgery before it is too late. The diagnosis of NEC is heavily dependent on interpretation of radiological findings, especially abdominal radiography (AR) and abdominal ultrasound (AUS). Interexpert variability in interpreting AR imaging, and in the case of AUS, performing and interpreting the test, remains an unresolved challenge. With the compounding impact of the shrinking radiology workforce, a novel approach is imperative. Computer assisted detection (CAD) and classification of abnormal pathology in medical imaging is a rapidly evolving field of clinical and biomedical research. This technology is widely used as a preliminary screening tool. This research paper proposes a deep learning-based model to classify AR images in an automated manner, generating class activation maps (CAM) from various imaging features consistent with NEC pathology, as agreed by expert consensus papers (in neonatology and paediatric radiology). It also compares it with conventional machine learning methods. The suggested model aims to produce heatmaps for various imaging features to highlight NEC pathology in AR (or in future AUS). Once the model is trained, validation is done through quantitative measures and visually by the attending radiologist (clinician) reviewing the validity of the colour maps highlighting the pathology of the AR image (future extension to AUS). As the volume of imaging data is increasing year by year, CAD can be a key strategy to assist radiology departments meet service needs. This technology can greatly assist in screening for NEC, improving the detection of NEC and potentially aid in the earlier identification of disease. Furthermore, it can fast track research cost effectively by creating big data through the automatic labeling of imaging data to create big-data for NEC databases.

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“…The incidence of NEC in VLBW infants, stable over the years, is between 5-7% (11,12); a slight increase over the period [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009] was reported in the intensive care unit neonatal (NICU) of the Vermont Oxford Network (VON) (12). Recently in UK an incidence of around 3% in infants <32 weeks' Review Article Diagnostic imaging features of necrotizing enterocolitis: a narrative review gestational age, between 2012 and 2013, was reported (13). Mortality from NEC varies depending from the degree of bowel involvement and comorbidities, up to 50% in those forms which require surgical treatment (1)(2)(3)6,14).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic imaging features of necrotizing enterocolitis: a narrative review

Esposito¹,

Mamone²,

Serafino³

et al. 2017

Quant. Imaging Med. Surg.

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Necrotizing enterocolitis (NEC) is an inflammatory process, characterized by intestinal necrosis of variable extension, leading to perforation, generalized peritonitis and death. The classical pathogenetic theory focuses on mucosal damage related to a stress induced intestinal ischemia leading to mucosal injury and bacterial colonization of the wall. A more recent hypothesis emphasizes the role of immaturity of gastrointestinal and immune system, particularly of the premature, responsible of bowel wall vulnerability and suffering. NEC is the most common gastrointestinal emergency in the newborn, with a higher incidence in the preterm; improvement of neonatal resuscitation techniques enables the survival of premature of very low birth weight (VLBW) with prolongation of hospital stay for perinatal and neonatal care and a higher risk of NEC. Clinical presentation of NEC in newborn ranges from mild forms with moderate gastrointestinal tract disorder and that can heal spontaneously, to very serious forms with fulminant course characterized by perforation, peritonitis, sepsis, disseminated intravascular coagulation (DIC) and shock. Imaging modality in the diagnosis of NEC is historically represented by the plain-film abdominal radiographs which can be performed every 6 hours because of the rapid evolution that may occur in the patient's clinical condition.However ultrasound (US), in recent years, is playing an increasingly important role in the evaluation of early stages of the disease as it provides images in real time of the abdominal structures being able to assess the presence and validity of peristalsis of the bowel loops, detect the thickness of the intestinal wall and the presence of minimal amounts of fluid in the peritoneal cavity. In this paper we review the pathogenesis, clinical presentation and imaging of NEC with a particular attention to the emergent role of US in the diagnosis of the disease.

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Necrotizing enterocolitis symposium: Epidemiology and early diagnosis

Abstract: Level V.

Cited by 23 publications

References 28 publications

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

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

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

Diagnostic imaging features of necrotizing enterocolitis: a narrative review

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