Abdominal Radiography and Ultrasound as a Diagnostic Method in Necrotizing Enterocolitis
Published
Sep 11, 2023
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Angie Natali Sierra Pérez
Miguel Andrés Otálora Baquero
https://orcid.org/0000-0002-8941-8299
Alfonso Lozada Medellín
Valentina Mogollón Portilla
Carlos Andres Rivera Bernal
Camila Guerrero Restrepo
https://orcid.org/0000-0002-8941-8299
Alfonso Lozada Medellín
Valentina Mogollón Portilla
Carlos Andres Rivera Bernal
Camila Guerrero Restrepo
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Abstract
Necrotizing enterocolitis (NEC) is the most frequently acquired gastrointestinal emergency in the neonatal period, mainly in preterm newborns. During the last quarter of a century, this pathology has emerged as an important factor in neonatal mortality. Severe cases can lead to intestinal perforation, systemic inflammatory response syndrome, multi-organ dysfunction, and death. With a global mortality rate that varies between 20 and 40%; reaching 60% in newborns with low birth weight once intestinal perforation has occurred. Traditionally, the gold standard for imaging evaluation and staging of the neonatal bowel has been abdominal radiography. Even so, this diagnostic method has proven to be non-specific for evaluating early characteristics related to dilated intestinal loops, ischemia, and necrosis. Early diagnosis is essential, which allows timely treatment, reducing the need for surgical procedures and secondary complications. The use of abdominal ultrasound with Doppler analysis as a diagnostic method for NEC has been proposed and described in the literature. This allows the evaluation of a greater spectrum of anomalies, does not produce ionizing radiation and has the ability to recognize intestinal necrosis prior to perforation or clinical deterioration. Therefore, in this document a review of the topic of ultrasound and abdominal radiography as diagnostic methods in NEC is carried out.
Keywords
recien nacido, radiografía abdominal, enfermedades gastrointestinales, enterocolitis necrosante, Ultrasonografia de abdomennewborn, ultrasonography, abdominal radiography, gastrointestinal diseases, diagnostic imaging
References
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4. Alexander KM, Chan SS, Opfer E, Cuna A, Fraser JD, Sharif S, Khashu M. Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed. 2021;106(1):F96-103. https://doi.org/10.1136/archdischild-2019-31838 1
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8. Castagnaro M, López J, Góngora A, Nishihara M. Radiografía directa de abdomen y correlación clínica en la enterocolitis necrotizante. Rev Arg Radiol [internet]. 2009;73(1):65-70. Disponible en: https://www.redalyc.org/pdf/3825/382538479005.pdf
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10. Janssen Lok M, Miyake H, Hock A, Daneman A, Pierro A, Offringa M. Value of abdominal ultrasound in management of necrotizing enterocolitis: a systematic review and meta-analysis. Pediatr Surg Int. 2018;34(6):589-612. https://doi.org/10.1007/s00383-018-4259-2
11. Chen S, Hu Y, Liu Q, Li X, Wang H, Wang K. Comparison of abdominal radiographs and sonography in prognostic prediction of infants with necrotizing enterocolitis. Pediatr Surg Int. 2018;34(5):535-41. https://doi.org/10.1007/s00383-018-4256-y
12. Ahle M, Ringertz HG, Rubesova E. The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature. Eur Radiol. 2018;28(9):3621-31. https://doi.org/10.1007/s00330-018-5362-x
13. Prithviraj D, Sandeep B, Suresh A, Balaraju V, Mondal S. 2015. Comparison between X-ray and abdominal ultrasound findings of necrotizing enterocolitis, its usefulness in early diagnosis, prognosis, and to assess, is this is the time to change our view of surgeon’s intervention according to the Bell’s criteria. Int J Sci Stud [internet]. 2015;3(4). Disponible en: https://www.ijss-sn.com/uploads/2/0/1/5/20153321/ijss_jul_oa26.pdf
14. Aliev MM, Dekhqonboev AA, Yuldashev RZ. Advantages of abdominal ultrasound in the management of infants with necrotizing enterocolitis. Pediatr Surg Int. 2017;33(2):213-16. https://doi.org/10.1007/s00383-016-4017-8
15. He Y, Zhong Y, Yu J, Ceng C, Wang Z, Li L. Ultrasonography and radiography findings predicted the need for surgery in patients with necrotising enterocolitis without pneumoperitoneum. Acta Paediatr. 2016 Apr;105(4):e151-5. https://doi.org/10.1111/apa.13315
16. Faingold R, Daneman A, Tomlinson G, Babyn PS, Manson DE, Mohanta A, et al. Necrotizing enterocolitis: assessment of bowel viability with color doppler US. Radiology. 2005 May;235(2):587-94. https://doi.org/10.1148/radiol.2352031718
17. Staryszak J, Stopa J, Kucharska-Miąsik I, Osuchowska M, Guz W, Błaż W. Usefulness of ultrasound examinations in the diagnostics of necrotizing enterocolitis. Pol J Radiol. 2015 Jan 1;80:1-9. https://doi.org/10.12659/PJR.890539
18. Van Druten J, Khashu M, Chan SS, et al. Abdominal ultrasound should become part of standard care for early diagnosis and management of necrotising enterocolitis: a narrative review. Arch Dis Child Fetal Neonatal Ed. 2019 Sep;104(5):F551-F559. https://doi.org/10.1136/ archdischild-2018-316263
19. Kim JH. Role of abdominal US in diagnosis of NEC. Clin Perinatol. 2019 Mar;46(1):119-27. https://doi.org/10.1016/j.clp.2018.10.006
20. Seliga-Siwecka J, Rutkowski J, Margas W, Puskarz-Gąsowska J, Bokiniec R. Sensitivity and specificity of different imaging modalities in diagnosing necrotising enterocolitis in a Polish population of preterm infants: A diagnostic test accuracy study protocol. BMJ Open. 2020;10(7):1-8. https://doi.org/10.1136/bmjopen-2019-033519
21. Muchantef K, Epelman M, Darge K, Kirpalani H, Laj P, Anupindi S. 2013. Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatr Radiol. 2013;43(11):1444-52. https://doi.org/10.1007/s00247-013-2725-y
22. Kim JH. Role of Abdominal US in Diagnosis of NEC. Clin Perinatol. 2019;46(1):119-27. https://doi.org/10.1016/j.clp.2018.10.006
23. Centro Nacional de Excelencia Tecnológica en Salud. Prevención, diagnóstico y tratamiento de enterocolitis necrosante del recién nacido en el segundo y tercer nivel de atención. Guía de evidencias y recomendaciones: guía de práctica clínica [internet]. Ciudad de México; 2018. Disponible en: http://www.cenetec-difusion.com/CMGPC/GPC-SS-481-18/ER.pdf
24. Oulego-Erroz I, Terroba-Seara S, Alonso-Quintela P, Jiménez-Gónzález A, Ardela-Díaz E. Ecografía a pie de cama en el diagnóstico precoz de la enterocolitis necrotizante: ¿una estrategia para mejorar el pronóstico. An Pediatr (Barc). 2020;93:411-3.
25. D’Angelo G, Impellizzeri P., Marseglia L, Montalto AS, Russo T, Salamone I, Gitto E. Current status of laboratory and imaging diagnosis of neonatal necrotizing enterocolitis. Ital J Pediatr. 2018;44(1):1-6. https://doi.org/10.1186/s13052-018-0528-3
26. Pose G, Arancibia ME, Soto G, Espinoza A, Fuentealba I, Reginensi CG. Neumatosis intestinal y alergia a la proteína de la leche de vaca. Rev Chil Radiol. 2008;14(2): 68-72. https://doi.org/10.4067/S0717-93082008000200005
27. Tracy SA, Lazow SP, Castro-Aragón IM, Fujii AM, Estroff JA, Parad RB, et al. Is abdominal sonography a useful adjunct to abdominal radiography in evaluating neonates with suspected necrotizing enterocolitis? J Am Col Surg. 2020;230(6):903-11.e2. https://doi.org/10.1016/j.jamcollsurg.2020.01.027
28. Cuna AC, Lee JC, Robinson AL, Allen NH, Foley JE, Chan SS. Bowel ultrasound for the diagnosis of necrotizing enterocolitis: a meta-analysis. Ultrasound Q. 2018 Sep;34(3):113-8. https://doi.org/10.1097/RUQ.0000000000000342
29. Caplan MS, Underwood MA, Modi N, Patel R, Gordon PV, Sylvester KG, et al. Necrotizing enterocolitis: using regulatory science and drug development to improve outcomes. J Pediatr. 2019;212:208-15.e1. https://doi.org/10.1016/j.jpeds.2019.05.032 33
30. Patel RM, Ferguson J, McElroy SJ, Khashu M, Caplan MS. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res. 2020 Aug;88(Suppl 1):10-5. https://doi.org/10.1038/s41390-020-1074-4
31. Elsayed Y, Seshia M. A new intestinal ultrasound integrated approach for the management of neonatal gut injury. Eur J Pediatr. 2022 Apr;181(4):1739-49. https://doi.org/10.1007/s00431-021-04353-z
2. Epelman M, Daneman A, Navarro OM, Morag I, Moore AM, Jae HK, Gerstle, JT. Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics. 2007;27(2):285-305. https://doi.org/10.1148/rg.27205509 11
3. Bohnhorst B. Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed. 2013 Sep;98(5):F445-50. https://doi.org/10.1136/archdischild-2012-302848
4. Alexander KM, Chan SS, Opfer E, Cuna A, Fraser JD, Sharif S, Khashu M. Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed. 2021;106(1):F96-103. https://doi.org/10.1136/archdischild-2019-31838 1
5. Chen S, Hu Y, Liu Q, Li X, Wang H, Wang K, ZhangA. Application of abdominal sonography in diagnosis of infants with necrotizing enterocolitis. Medicine (United States). 2019;98(28). https://doi.org/10.1097/MD.000000000001620 8
6. Brigham and Women's Hospital. Pediatric newborn medicine clinical practice guidelines: diagnostic evaluation of necrotizing enterocolitis (NEC). 2019.
7. Shebrya NH, Amin SK, El-Shinnawy MA, Imam SS. Abdominal ultrasonography in preterm necrotizing enterocolitis. Is it superior to plain radiography? Egypt J Radiol Nucl Med. 2012;43(3):457-63. https://doi.org/10.1016/j.ejrnm.2012.06.001
8. Castagnaro M, López J, Góngora A, Nishihara M. Radiografía directa de abdomen y correlación clínica en la enterocolitis necrotizante. Rev Arg Radiol [internet]. 2009;73(1):65-70. Disponible en: https://www.redalyc.org/pdf/3825/382538479005.pdf
9. Deeg KH. Sonographic and Doppler sonographic diagnosis of necrotizing enterocolitis in preterm infants and newborns. Ultraschall Med. 2019;40(3):292-318. https://doi.org/10.1055/a-0879-8110 9
10. Janssen Lok M, Miyake H, Hock A, Daneman A, Pierro A, Offringa M. Value of abdominal ultrasound in management of necrotizing enterocolitis: a systematic review and meta-analysis. Pediatr Surg Int. 2018;34(6):589-612. https://doi.org/10.1007/s00383-018-4259-2
11. Chen S, Hu Y, Liu Q, Li X, Wang H, Wang K. Comparison of abdominal radiographs and sonography in prognostic prediction of infants with necrotizing enterocolitis. Pediatr Surg Int. 2018;34(5):535-41. https://doi.org/10.1007/s00383-018-4256-y
12. Ahle M, Ringertz HG, Rubesova E. The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature. Eur Radiol. 2018;28(9):3621-31. https://doi.org/10.1007/s00330-018-5362-x
13. Prithviraj D, Sandeep B, Suresh A, Balaraju V, Mondal S. 2015. Comparison between X-ray and abdominal ultrasound findings of necrotizing enterocolitis, its usefulness in early diagnosis, prognosis, and to assess, is this is the time to change our view of surgeon’s intervention according to the Bell’s criteria. Int J Sci Stud [internet]. 2015;3(4). Disponible en: https://www.ijss-sn.com/uploads/2/0/1/5/20153321/ijss_jul_oa26.pdf
14. Aliev MM, Dekhqonboev AA, Yuldashev RZ. Advantages of abdominal ultrasound in the management of infants with necrotizing enterocolitis. Pediatr Surg Int. 2017;33(2):213-16. https://doi.org/10.1007/s00383-016-4017-8
15. He Y, Zhong Y, Yu J, Ceng C, Wang Z, Li L. Ultrasonography and radiography findings predicted the need for surgery in patients with necrotising enterocolitis without pneumoperitoneum. Acta Paediatr. 2016 Apr;105(4):e151-5. https://doi.org/10.1111/apa.13315
16. Faingold R, Daneman A, Tomlinson G, Babyn PS, Manson DE, Mohanta A, et al. Necrotizing enterocolitis: assessment of bowel viability with color doppler US. Radiology. 2005 May;235(2):587-94. https://doi.org/10.1148/radiol.2352031718
17. Staryszak J, Stopa J, Kucharska-Miąsik I, Osuchowska M, Guz W, Błaż W. Usefulness of ultrasound examinations in the diagnostics of necrotizing enterocolitis. Pol J Radiol. 2015 Jan 1;80:1-9. https://doi.org/10.12659/PJR.890539
18. Van Druten J, Khashu M, Chan SS, et al. Abdominal ultrasound should become part of standard care for early diagnosis and management of necrotising enterocolitis: a narrative review. Arch Dis Child Fetal Neonatal Ed. 2019 Sep;104(5):F551-F559. https://doi.org/10.1136/ archdischild-2018-316263
19. Kim JH. Role of abdominal US in diagnosis of NEC. Clin Perinatol. 2019 Mar;46(1):119-27. https://doi.org/10.1016/j.clp.2018.10.006
20. Seliga-Siwecka J, Rutkowski J, Margas W, Puskarz-Gąsowska J, Bokiniec R. Sensitivity and specificity of different imaging modalities in diagnosing necrotising enterocolitis in a Polish population of preterm infants: A diagnostic test accuracy study protocol. BMJ Open. 2020;10(7):1-8. https://doi.org/10.1136/bmjopen-2019-033519
21. Muchantef K, Epelman M, Darge K, Kirpalani H, Laj P, Anupindi S. 2013. Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatr Radiol. 2013;43(11):1444-52. https://doi.org/10.1007/s00247-013-2725-y
22. Kim JH. Role of Abdominal US in Diagnosis of NEC. Clin Perinatol. 2019;46(1):119-27. https://doi.org/10.1016/j.clp.2018.10.006
23. Centro Nacional de Excelencia Tecnológica en Salud. Prevención, diagnóstico y tratamiento de enterocolitis necrosante del recién nacido en el segundo y tercer nivel de atención. Guía de evidencias y recomendaciones: guía de práctica clínica [internet]. Ciudad de México; 2018. Disponible en: http://www.cenetec-difusion.com/CMGPC/GPC-SS-481-18/ER.pdf
24. Oulego-Erroz I, Terroba-Seara S, Alonso-Quintela P, Jiménez-Gónzález A, Ardela-Díaz E. Ecografía a pie de cama en el diagnóstico precoz de la enterocolitis necrotizante: ¿una estrategia para mejorar el pronóstico. An Pediatr (Barc). 2020;93:411-3.
25. D’Angelo G, Impellizzeri P., Marseglia L, Montalto AS, Russo T, Salamone I, Gitto E. Current status of laboratory and imaging diagnosis of neonatal necrotizing enterocolitis. Ital J Pediatr. 2018;44(1):1-6. https://doi.org/10.1186/s13052-018-0528-3
26. Pose G, Arancibia ME, Soto G, Espinoza A, Fuentealba I, Reginensi CG. Neumatosis intestinal y alergia a la proteína de la leche de vaca. Rev Chil Radiol. 2008;14(2): 68-72. https://doi.org/10.4067/S0717-93082008000200005
27. Tracy SA, Lazow SP, Castro-Aragón IM, Fujii AM, Estroff JA, Parad RB, et al. Is abdominal sonography a useful adjunct to abdominal radiography in evaluating neonates with suspected necrotizing enterocolitis? J Am Col Surg. 2020;230(6):903-11.e2. https://doi.org/10.1016/j.jamcollsurg.2020.01.027
28. Cuna AC, Lee JC, Robinson AL, Allen NH, Foley JE, Chan SS. Bowel ultrasound for the diagnosis of necrotizing enterocolitis: a meta-analysis. Ultrasound Q. 2018 Sep;34(3):113-8. https://doi.org/10.1097/RUQ.0000000000000342
29. Caplan MS, Underwood MA, Modi N, Patel R, Gordon PV, Sylvester KG, et al. Necrotizing enterocolitis: using regulatory science and drug development to improve outcomes. J Pediatr. 2019;212:208-15.e1. https://doi.org/10.1016/j.jpeds.2019.05.032 33
30. Patel RM, Ferguson J, McElroy SJ, Khashu M, Caplan MS. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res. 2020 Aug;88(Suppl 1):10-5. https://doi.org/10.1038/s41390-020-1074-4
31. Elsayed Y, Seshia M. A new intestinal ultrasound integrated approach for the management of neonatal gut injury. Eur J Pediatr. 2022 Apr;181(4):1739-49. https://doi.org/10.1007/s00431-021-04353-z
How to Cite
Sierra Pérez, A. N., Otálora Baquero, M. A., Medellín , A. L., Mogollón Portilla , V., Rivera Bernal, C. A., & Guerrero Restrepo , C. (2023). Abdominal Radiography and Ultrasound as a Diagnostic Method in Necrotizing Enterocolitis. Universitas Medica, 64(3). https://doi.org/10.11144/Javeriana.umed64-3.ream
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Suplemento Especial de Pedriatría
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