Back to 2025 Abstracts
Utility of pre-operative ultrasound for surgical decision making in neonates diagnosed with necrotizing enterocolitis
Elena M. Wilson
*, Zane J. Hellmann, Connor V. Haynes, Daniel G. Solomon, Emily R. Christison-Lagay
Pediatric Surgery, Yale University School of Medicine, New Haven, CT
Background:When determining timing and need for surgery in neonates with necrotizing enterocolitis (NEC), abdominal x-ray and clinical changes, in the absence of pneumoperitoneum, have traditionally guided surgical decision-making. Ultrasonography (US) may provide additional information on extent of pneumatosis, portal venous gas, mural stratification loss, and presence of complex fluid, suggestive of perforation. We hypothesized hospitals with high US utilization would have lower surgical rates, without compromising mortality in NEC neonates.
Study Design:The Pediatric Health Information System (PHIS) identified NEC patients by ICD-10 code, born between 2016-2023. Data on mortality, surgical intervention, US, mechanical ventilation, and TPN use were collected. US utilization terciles were defined by the proportion of children receiving US within 48 hours of exploratory laparotomy relative to all exploratory laparotomies performed at each hospital. Comparisons were made between the lowest and highest terciles. Primary outcome was progression to surgery; secondary outcome was mortality.
Results:7901 neonates had a NEC diagnosis, of whom 2002 underwent exploration. 337 of explored neonates had sonographic imaging within 48 hours preceding exploration. US utilization varied widely by hospital; with high utilization hospitals obtaining US in 30.7% of neonates prior to laparotomy, compared to 4.5% at low utilization hospitals (p=<0.001). At high utilization hospitals, 24.4% of NEC neonates underwent exploratory laparotomy, compared to 27.8% of patients at low utilization hospitals (p=0.008; Table 1).
Multivariable logistic regression adjusted for gestational age, birthweight, and sex, showed a 27% lower likelihood of exploration for children admitted to high utilization hospitals compared to low utilization hospitals (OR= 0.73, 95% CI 0.64-0.84, p =<0.001). Among all neonates with NEC, those admitted to high utilization hospitals were no more likely to die during index admission compared to those admitted to low utilization hospitals (OR= 0.91, 95% CI 0.78-1.06, p = 0.232). Additionally, there was no difference in mortality between high and low utilization hospitals following exploratory laparotomy for NEC (OR=1.23, 95% CI 0.95-1.59, p =0.119).
Conclusions:Neonates at hospitals with high US utilization are significantly less likely to undergo laparotomy for necrotizing enterocolitis. Mortality did not differ between high and low utilization hospitals, suggesting US may aid in selection of patients who may most benefit from surgical exploration, who also have ambiguous abdominal plain films. Further studies are needed to elucidate how US utilization influences more granular decisions regarding surgical timing and management, and the effect it may have on outcomes.
Table 1: Demographics by US Tercile for NEC Neonates
| | Total | Low US Tercile | High US-Tercile | p-value |
| | n=5,153 | n=2,082 | n=3,071 | |
| Female | 2,125 (41.2%) | 834 (40.1%) | 1,291 (42.0%) | 0.170 |
| White | 1,768 (34.3%) | 658 (31.6%) | 1,110 (36.1%) | <0.001 |
| Commercial (Insurance) | 1,655 (32.1%) | 601 (28.9%) | 1,054 (34.3%) | <0.001 |
| Birthweight (grams) | 1130.0 (720.0-2010.0) | 1090.0 (710.0-1960.0) | 1155.0 (732.0-2020.0) | 0.018 |
| Gestational Age (weeks) | 29.0 (25.0-34.0) | 28.0 (25.0-34.0) | 29.0 (25.0-34.0) | 0.230 |
| Overall Length of Stay | 76.0 (35.0-130.0) | 75.0 (33.0-127.0) | 78.0 (36.0-131.0) | 0.067 |
| Laparotomy | 1,328 (25.8%) | 578 (27.8%) | 750 (24.4%) | 0.008 |
Laparotomy
US Within 48 Hours | 256 (19.3%) | 26 (4.5%) | 230 (30.7%) | <0.001 |
| Mortality | 943 (18.3%) | 388 (18.6%) | 555 (18.1%) | 0.610 |
Back to 2025 Abstracts
