Neonatologist Performed Bedside Ultrasound for Early Diagnosis of Necrotizing Enterocolitis: A Pilot Before-after Study

Abstract Purpose To assess whether bedside ultrasound (BUS) improves early diagnosis of necrotizing enterocolitis (NEC). Methods Before-after controlled study in two NICUs. Infants below 37 weeks of gestational age with suspected NEC were eligible. The intervention group (October 2019-October 2021) received BUS as first imaging modality and treatment was guided by BUS findings. The control group (October 2015-September 2019) received radiography as first imaging modality and was managed accordingly. The main outcome was NEC confirmation at the time of initial imaging. Secondary outcomes included radiographic and laboratory data, treatment requirements, surgical NEC and NEC-related death: Results Thirty-five episodes of suspected NEC with 14 (40%) confirmed NEC cases and 49 episodes of suspected NEC with 22 (44.9%) confirmed NEC cases were included in the intervention and control group respectively. In the intervention group 14 of 14 (100%) NEC cases were confirmed at initial evaluation compared to 10 of 22 (45.4%) in the control group (p = 0.001). Infants managed with BUS developed thrombocytopenia and coagulopathy less frequently, were exposed to less radiation, progressed less frequently to Bell’s stage ≥ II and required less days of parenteral nutrition compared to the control group (p < 0.05). Surgical NEC [4 of 14 (28.6%) vs 8 of 22 (36.7%); p = 0.727] and NEC-related death [0 of 14 (0%) vs 5 of 22 (22.7%); p = 0.133] were not different. Conclusions The use of BUS as first imaging modality resulted in an earlier diagnosis of NEC compared to abdominal radiography. Further research should determine the potential of BUS to improve outcomes.