Is Abdominal Ultrasound a Useful Adjunct to Abdominal Radiograph in Neonates with Necrotizing Enterocolitis?
*Sarah Tracy1, *Stefanie Lazow1, *Ilse Castro-Aragon2, *Alan Fujii2, *Judy Estroff1, *Richard Parad3, *David Zurakowski1, Catherine Chen1
1Boston Children's Hospital, Boston, MA;2Boston Medical Center, Boston, MA;3Brigham and Women's Hospital, Boston, MA
Objective(s): Serial abdominal radiographs (AXR) have been the criterion standard imaging study for diagnosis and monitoring of necrotizing enterocolitis (NEC). However, abdominal ultrasound (AUS) is emerging as an attractive adjunct. We sought to evaluate concordance between AUS and AXR findings of pneumatosis and portal venous gas in neonates with suspected NEC.
Design: Multi-center retrospective review
. Findings were abstracted from reports.
Setting: Hospitalized care.
Patients: Seventy patients from three level III-IV NICUs with clinical concern for NEC from 2009-2018. Eleven patients underwent cardiac surgery (other than PDA ligation) in the neonatal period. Patients had at least one AXR followed by an AUS within 48 hours. Indications for AUS and AXR included symptoms concerning for NEC or previous abnormal studies.
Interventions: n/a.
Main Outcome Measure(s): Concordance between AUS and AXR findings of pneumatosis and portal venous gas in patients with suspected NEC.
Results: Seventy patients had a total of 108 paired studies. Agreement between the two imaging modalities was 64% (Kappa = 0.32, 95%CI 0.13- 0.50) and 65% (Kappa = 0.04, 95%CI 0.00-0.66) in the subgroup of cardiac surgery patients. Of the discordant pairings, 33/39 (85%) had a positive AUS (Table 1).
Conclusions: Abdominal ultrasound and radiograph have, at best, moderate concordance for pneumatosis and/or portal venous gas in typical neonatal intensive care unit populations. When abdominal ultrasound is done along with radiographs, it may provide useful additional information to help make the diagnosis of necrotizing enterocolitis and guide medical management. 
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