Ultrasound, Doppler ,and Calprotectin in Necrotizing Enterocolitis Diagnosis
Ultrasound, Doppler ,and Calprotectin in Necrotizing Enterocolitis Diagnosis
Necrotizing enterocolitis continues to be a disease that is associated with significant
 morbidity and mortality in premature infants due to advances in neonatal intensive care that
 increase the survival rate of extremely low birth weight infants (below 1,000 gram)
Necrotizing enterocolitis continues to be a disease that is associated with significant
 morbidity and mortality in premature infants. It affects annually 0.72 infants per 1000 live
 births among all neonates and 33 infants per 1000 live births among very low-birth-weight
 (below 1500 gram).

 Necrotising enterocolitis presents with both gastrointestinal and systemic signs.
 Gastrointestinal signs as delayed gastric emptying, abdominal distention and bloody stools.
 Non specific signs as lethargy, apnea, respiratory distress.

 Although clinical and characteristic radiological findings remain the most important tools so
 far. Unfortunately, these signs are usually detectable in an advanced stage of disease.

 -  Haematological studies as severe or persistent thrombocytopenia, neutropenia,
 coagulopathy, or acidosis might indicate severe disease.

 -  Serial C-reactive protein : that persistently high C-reactive protein indicated
 developing complications, such as stricture or abscess.

 Unfortunately, the majority of these biomarkers lack accuracy in preclinical stage and do not
 allow proper discrimination from sepsis Therefore, the search for disease-specific, early and
 noninvasive diagnostic biomarkers remains warranted.

 Calprotectin, a peptide secreted by neutrophils and macrophages and is a useful laboratory
 biomarker for diagnosing necrotizing enterocolitis . Its non-specific biomarkers of
 inflammation, but the nature of the specimen, e.g. stool, renders these mediators more
 indicative of the site of tissue injury. And its levels may be a marker for early diagnosis
 and resolution of gastrointestinal illness , but its utility for early diagnosis and
 assessment of resolution of necrotizing enterocolitis needs to be studied in a larger
 studies.

 Plain X ray: Definite signs include pneumatosis intestinalis (intramural air) and portal
 venous gas .

 Ultrasound : More sensitive and accurate imaging studies and could become helpful adjuncts to
 abdominal films in the diagnosis of necrotizing enterocolitis .

 The major advantage of sonography over plain abdominal radiography is its superiority in
 depicting small amount of gas. Ultrasound with Doppler might be more sensitive than abdominal
 films for detecting necrotic bowel requiring surgical intervention.

 When necrotizing enterocolitis is suspected, infants are given bowel rest , bowel
 decompression, and broad-spectrum antibiotics (after cultures are obtained). Anaerobic
 coverage should be considered. Adjunctive therapy includes cardiovascular, pulmonary, and
 haematological support as clinically indicated.

 The two main options available for the surgical management of necrotizing enterocolitis are
 exploratory laparotomy and primary peritoneal drainage .
Inclusion Criteria:

 -  Include All cases with necrotizing enterocolitis (NEC) in assiut university neonatal
 intensive care unit (NICU) who are presented with any stage of Bell's stages of
 necrotising enterocolitis within one year .

 I. Suspected disease Mild systemic signs (apnoea, bradycardia, temperature instability)
 Mild intestinal signs (abdominal distention, gastric residuals, bloody stools) Non-specific
 or normal radiological signs II. Definite disease Mild to moderate systemic signs
 Additional intestinal signs (absent bowel sounds, abdominal tenderness) Specific radiologic
 signs (pneumatosis intestinalis or portal venous air) Laboratory changes (metabolic
 acidosis, thrombocytopaenia) III. Advanced disease Severe systemic illness (hypotension)
 Additional intestinal signs (striking abdominal distention, peritonitis) Severe
 radiological signs (pneumoperitoneum) Additional laboratory changes (metabolic and
 respiratory acidosis, disseminated intravascular coagulopathy).

 Exclusion Criteria:surgical problems other than NEC ,NEC beyond neonatal period.

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