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.

Graphical abstract

中文翻译：

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简短超声在评估坏死性小肠结肠炎中的作用

背景

肠道超声是诊断和治疗坏死性小肠结肠炎 (NEC) 的有用诊断工具，但可能非常耗时且需要技术专业知识，特别是在评估积气时。先前关于 NEC 超声检查评估的文献主要集中在全肠道超声方案上，但主要旨在识别高风险超声检查结果而不进行重点肠道评估的简化方案的实用性尚未得到充分研究。

客观的

本研究旨在描述用于识别高风险 NEC 结果的简化超声方案的诊断准确性。

材料和方法

这是一项经机构审查委员会批准的回顾性研究。我们确定了 2014 年 1 月至 2022 年 8 月期间在我们机构进行的所有简化 NEC 超声检查。检查检查是否存在高风险发现，包括气腹、积液和复杂的游离液体。临床结果分为不良或良好，具体取决于是否发生与 NEC 相关的紧急手术干预或死亡。对后续 NEC 超声检查的频率进行了审查，以确定新的发现是否会影响结果。生成灵敏度、特异性以及阳性和阴性预测值，以评估简化超声检查的性能，以识别高风险结果。

结果

总共对 73 名儿童进行了 84 次简短腹部超声检查。超声检查时的中位年龄为 41 天（四分位距 (IQR) 53 天），中位孕龄为 35 周零 3 天（IQR 80 天），44/73 (60%) 为男性。 13 次超声检查至少有一项高风险发现，其中 9 次 (69%) 导致结果不佳，其中包括 7 次手术干预和 4 例死亡。两名患者接受手术干预后因坏死性小肠结肠炎死亡。没有高风险发现的超声检查与不良临床结果无关。简化 NEC 超声的敏感性、特异性、阳性预测值和阴性预测值分别为 100% (95% CI 60–100%)、95% (95% CI 86–98%)、69% (95% CI 39–分别为 90%）和 100%（95% CI 94–100%）。 12 次简短超声检查后，5 天内进行了第二次 NEC 超声检查。五次后续超声检查显示了新的高风险或低风险发现，但新发现与初始超声预测的结果变化无关。

结论

简化的 NEC 超声检查可在预测不良结果方面具有临床实用性，特别是在资源有限的非工作时间。

图形概要