Imaging Modalities in Diagnosing Necrotizing Enterocolitis in Preterm Infants.
Imaging Modalities in Diagnosing Necrotizing Enterocolitis in Preterm Infants.
Background Necrotizing enterocolitis (NEC) is one of the most serious conditions in newborns,
 affecting up to 10% of very low birth weight infants (VLBW). In the most premature population
 mortality rates can rise as high as 60%.

 Typical findings on abdominal radiography (AR) include pnuematosis intestinalis (PI), portal
 vein gas (PVG) and pneumoperitoneum, but are sometimes not present even in severe cases.
 Abdominal ultrasound (AUS) can depict PI, PVG and pnuemoperitoneum (in some cases a head of
 AR), but it also provides other crucial information such as bowel wall viability (thickness
 or thinning) and free abdominal fluid. These additional findings are helpful in expediting
 diagnosis and management of NEC.

 Methods and analysis The hypothesis being tested is that preforming an AUR in patients with
 clinical symptoms of NEC but inconclusive/normal AR will enhance detection rates, and
 expedite treatment in infants born at <32 weeks.

 Discussion The use of AUS together with AR as an add-on test may increase the accuracy of
 diagnosing NEC, and precipitate treatment. Swift implementation of antibiotics and bowel rest
 is extremely important. To our best knowledge, our study will be the first to focus only on
 VLBW, who are most prone to NEC. It will also be the first multi-centre study evaluating the
 use of AUS as an add-on test, enabling us to recruit a significantly higher number of
 patients compared to published studies.
Inclusion Criteria:

 -  Abdominal distension

 -  Visible bowels loops

 -  Feeding intolerance (defined as emesis ≥ 2 consecutive feeds, or gastric residuals of
 >50% per feed in ≥ 2 consecutive feeds, bilious residuals, bilious emesis)

 -  Temperature instability (defined as ≥ 2 consecutive measurements)

 -  Frank bloody stools

 -  Cardiovascular instability (hypotension; defined as MAP < 30mmHg, tachycardia >160/'
 or bradycardia < 80/')

 -  Recurrent apnea

 -  Increase of abdominal girth > 2cm (allowing inter-observer variability of 1 cm) within
 12 h

 -  Abdominal wall erythemia

 And/or at least 2 of the below laboratory findings5:

 -  Thrombocytopenia < 50 x103/uL

 -  Leukopenia <6 x106/uL

 -  CRP > 10 mg/L

 -  PCT > 1 ng/ml

 -  Coagulopathy

 Exclusion Criteria:

 -  • < 22 weeks of gestational age or > 32 weeks (estimated by ultrasound)

 -  Congenital abnormalities

 -  No parental consent