Value of abdominal ultrasonography in predicting intestinal resection for premature infants with necrotizing enterocolitis

Abstract

Background: Abdominal ultrasonography (AUS) has been suggested to be valuable in the early detection of necrotizing enterocolitis (NEC). Objective: Here, we intended to assess the efficiency of abdominal ultrasound in terms of predicting bowel resection in infants with NEC. Methods: From January 2018 to March 2021, 164 hospitalized children with NEC who underwent surgical management were enrolled. The enrolled infants were separated into two groups according to whether they underwent bowel resection. We reviewed the clinical data, as well as dynamic sonographic and abdominal radiographic (AR) parameters. The potential performance of AUS parameters was identified and compared with that of AR using a logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results: Several parameters were detected to be statistically significant in predicting the occurrence of bowel resection, including thick to thin transformation [p < 0.001, odds ratios (OR), 4.38; 95% confidence interval (CI) 2.26–8.52], absence of peristalsis certain areas (p = 0.001, OR, 2.99; 95% CI 1.53–5.86), absence of bowel wall perfusion (p < 0.001, OR 10.56; 95% CI 5.09–21.90), and portal venous gas (p = 0.016, OR, 2.21; 95% CI 1.12–4.37). Furthermore, the ROC curve analysis showed significant differences (p = 0.0021) in the area under the receiver operating curve (AUROC) for the logistic models of AUS (AUROC: 0.755, 95% CI 0.660–0.849) and AR (AUROC: 0.693, 95% CI 0.597–0.789) for the prediction of intestinal resection. Conclusions: A dynamic AUS examination play an important role to indicate the potential for bowel loss during the surgery.