title: Complex Fluid Collection on Abdominal Ultrasound Indicates Need for Surgery in Neonates with Necrotizing Enterocolitis.
abstract: AimThe aim of this study was to determine whether a correlation exists between the sonographic findings and the clinical outcomes, defined as surgery or death, in neonates with radiographically and/or histopathologically confirmed necrotizing enterocolitis (NEC).Material and MethodsIn this retrospective study, the case notes of 58 patients admitted to Karolinska University Hospital, Stockholm, Sweden, with radiographically confirmed NEC from September 2010 to August 2013, were reviewed. We included all newborns who underwent both plain abdominal radiographs and an abdominal ultrasound on the same day. The images were reviewed retrospectively. Patients' characteristics, clinical data, and histopathological data were recorded from the case notes. We excluded newborns who developed free gas before surgery. Abdominal ultrasound images were reviewed for free intraperitoneal gas, peritoneal fluid, pneumatosis intestinalis, portal gas, bowel vascularity, bowel wall thickness, and peristalsis. We correlated the sonographic features with the clinical outcomes; defined as the need for surgery or death.ResultsOverall, 25 neonates were included. Out of these, 11 patients underwent surgery and 5 patients died. The sonographic finding of complex fluid collection was statistically significant, predicting severe NEC that needed surgery. No other sonographic features were related to the need for surgery or death.ConclusionComplex fluid collection shown with abdominal ultrasound appears to be strongly correlated to the need for surgery in newborn infants with severe NEC.
authors.affiliation: Department of Neonatology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: Elena
authors.initials: E
authors.lastname: Palleri
authors.affiliation: Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Kaiser
authors.affiliation: Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Wester
authors.affiliation: Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Arnell
authors.affiliation: Department of Neonatology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: Marco
authors.initials: M
authors.lastname: Bartocci
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D020345:Enterocolitis, Necrotizing / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014463:Ultrasonography / Q000379:methods