Use of point of care bowel ultrasound for diagnosis of suspected necrotizing enterocolitis: A feasibility study

Necrotizing enterocolitis (NEC) is a potentially fatal comorbidity of prematurity with one in five affected requiring surgical intervention. Despite its seriousness, there is lack of objective radiographic criteria on plain abdomnial radiographs (X-ray) to guide prognosis and decision making. Point of care bowel ultrasound (BUS) provides a more dynamic assessment and more information around bowel health. However, there is lack of widespread adoption of this practice by neonatologists due to training opportunities and inconsistent support from radiologists. We present a feasibility study from UK of using point of care bowel ultrasound in conjunction with X-ray to aid diagnosis of NEC. We report that that neonatologist performed BUS when used as an additional diagnostic aid has a higher positive predictive value and specificity compared to X-rays alone. Features like absent or poor peristalsis and abnormal bowel perfusion were the most consistent pathological findings in our cohort. Wider implementation of this practice is limited by training opportunities and dedicated support from radiology team.