Abdominal Ultrasound In Diagnosing Neonatal Necrotising Enterocolitis And Correlation With Outcomes

Objective:The sonographic and radiographic imaging features of the neonatewith necrotizing enterocolitis of84cases were summarized, to analysisthe role of abdominal ultrasound in the diagnosis of NEC. Correlationanalysis were carried out on the sonographic findings and prognosis ofNEC to evaluate the value of abdominal ultrasound in treating NEC, inorder to provide clinical basis for the diagnosis and treatment of NEC.Methods:This was a retrospective clinical analysis, the clinical manifestations,laboratory records, as well as abdominal sonographic and radiographicexams of infants diagnosed as NEC from July2013to January2015inThe First Hospital Bethune Jilin University were collected. All cases weredivided into suspected NEC group (44case) and confirmed NEC group(40case) according to the revised Bell staging criteria, and then patientswere categorized into two groups again based on clinical outcomes, onegroup comprised of58neonates were treated medically and recoveredfully, another group comprised of26neonates were infants who requiredsurgery or died at last. The software of EXCEL and SPSS21.0were usedfor statistical analysis.Result:1.84cases of NEC were included in this research, including55cases of male and29cases of female. There were62premature infants and22term infants. The clinical manifestations varied obviously,abdominal distension (57cases) was one of the most commongastrointestinal symptoms, which accounted for67.9%. The nonspecificsystemic clinical manifestations were apnea, lethargy, or temperatureinstability.2. The cases diagnosed as septicemia in confirmed NEC group was11（27.5%）, and in the suspected NEC group was4(9.1%)，whichindicated a significant difference (P=0.03) between two groups.3. In the proven NEC group, the positive rate of portal venous gasand the dilatation of intestine diagnosed through abdominal ultrasoundwere higher than abdominal radiograph, There was a significantdifference between two groups (P=0.04and P=0.03,respectively). Nosignificant difference was found in the pneumatosis intestinalis,intraperitoneal gas and bowel wall thickening between two groups.4. The risk ratio and95%CI for these sonographic findings werecalculated in the group who were treated medically and recovered fullyand the group who required surgery or died at last. The dilatation ofintestine，bowel wall thickening and free fluid with echoes indicated byabdominal ultrasound in the group who required surgery or died werehigher than the group who were treated medically and recovered fully,which had statistically significant difference. The risk ratio and95%CIwere respectively2.1(1.3-3.3),2.4(1.2-4.7) and19.6(2.6-147.2). Thedilatation of intestine of radiograph in both groups was significantlydifferent, and the risk ratio and95%CI was1.8(1.1-3.1）.Conclusion：1. The rates of portal venous gas and the dilatation of intestine offound by abdominal ultrasound were higher than abdominal radiograph,and ultrasound not only can avoid radiation exposure but also offers important advantages including direct visualization of bowel peristalsisand seroperitoneum. So compared to abdominal radiograph, theabdominal ultrasound played a primary role in the diagnosis of NEC andhad its advantages in some ways.2. The rates of sonographic findings which contained the dilatation ofintestine, bowel wall thickening and free fluid with echoes were higher inthe group who required surgery or died, the presence of these findingswere predictive signs for a poor outcome. As a result, the abdominalultrasound is useful in predicting clinical outcomes.