| Objective: To investigate the application value of ultrasound(US)in diagnosis and prognostic evaluation of neonatal necrotizing enterocolitis(NEC).Methods:A retrospective study of 70 patients,presenting with NEC between October 2010 and October 2022.According to the revised Bell-NEC classification criteria,they were 37 cases in suspected group(stage I)and 33 cases in confirmed group(≥ stage II).In light of the clinical outcome,They were 34 cases in medical treatment group and 36 cases insurgery/death group.SIEMENS ACUSON Sequoia,Phillips IU22 and Phillips CX50 color Doppler ultrasonography instrument was used to scan thebowel and abdominal cavity.The positive detection was compared between US and abdominal X-ray results.In term of the severity of ultrasound signs assign scores and draw receiver operating characteristic(ROC)curve.The ROC curve was drawn to evaluate the predictive value of ultrasound for the poor outcome of NEC children.SPSS 25.0 statistical software was used for statistical analysis.Results:1.70 patients were enrolled in this study,including 37 males and 33 females.The mean gestational age was 31.9 ± 3.8 weeks,including 61 premature infants(gestational age<37weeks).The birth weight of the children was 700-3850 g,the average weight was(1738±848.9)g,including 35 very low weight infants(<1500g).There were 30 cases of bloody stool and 35 cases of abdominal distension.There were statistically significant differences in CRP values between suspected group and confirmed group There were statistically significant differences in Platelet count and CRP value between medical treatment group and surgery/death group.2.Comparison of the feature of US in each groupIn the comparison of ultrasound,there were significant difference inportal vein gas,free intraperitoneal air and ascites between suspected group and confirmed group.There were significant differences in free intraperitoneal air and ascites between medical treatment group and surgery/death group.They could be used as indicators to predict poor outcome of the disease.3.Comparison of the feature of abdominal X-ray in each groupThe different results of portal free intraperitoneal air and bowel dilatation between suspected group and confirmed group were statistically significant.In the comparison of abdominal X-ray,two groups did not differ significantly in terms of all features.They could not be used as an indicator to predict poor outcome of NEC.4.Comparison of US and abdominal X-ray features in each groupThere were significant difference in bowel wall thickening,bowel dilatation,intramural gas,ascites and reduced intestinal peristalsis in suspected group between US and abdominal X-ray results.Abdominal X-ray found no portal vein gas and free intraperitoneal air,while ultrasound found 2cases portal vein gas and 2 cases free intraperitoneal air.In confirmed group,there were significant difference between ultrasound and abdominal X-ray results,including bowel wall thickening,intramural gas,portal vein gas,reduced intestinal peristalsis,free intraperitoneal air and ascites.5.AUC obtained by constructing ROC curve was 0.784.With ≥5 points as the cutoff value,the accuracy and sensitivity value were 77.8% and 67.6% respectively.Conclusions:1.When Clinical symptoms of NEC appeared,CRP value increased,and ultrasound features appeared,including bowel wall thickening,boweldilatation,intramural gas,portal vein gas,free intraperitoneal air,reduced intestinal peristalsis,free intraperitoneal air and ascites,NEC should be highly suspected.the children should be diagnosed and treated as early as possible.2.Compared with abdominal X-ray,ultrasound indicated a higher detection rate of bowel wall thickening,bowel dilatation,intramural gas,portal vein gas,reduced intestinal peristalsis,free intraperitoneal air and ascites.3.US suggested that free intraperitoneal air and ascites could be used as indicators of poor outcome and provide valuable information on surgical decision making.Portal vein gas was not regarded as the poor outcome of NEC.4.With the score of ultrasound signs scale≥5.5 points as the cutoffvalue suggested poor outcome and provided valuable information on surgical decision making... |
