SCREENING METHODS FOR RADIOLOGICAL DIAGNOSIS OF NECROTIZING ENTEROCOLITIS IN PRETERM NEWBORNS

Necrotizing enterocolitis is a severe disease with a mortality rate among premature infants of up to 60%. The standard imaging algorithm for necrotizing enterocolitis combines radiographs and clinical signs, which together constitute Bell's staging criteria. Therefore, early and accurate diagnosis, as well as the prompt initiation of appropriate management, are of vital importance. A clinically suspected diagnosis is typically confirmed by findings on plain abdominal radiography: pneumatosis intestinalis, portal venous gas, and pneumoperitoneum in cases of bowel per­foration. Recently, accumulating evidence has shown that real-time ultrasound is significantly more effective than radiography at detecting intramural gas and portal venous gas. In addition, ultrasound enables direct assessment of the bowel wall, identifying thickening or thinning, decreased peristalsis, or impaired wall perfusion. Intraluminal and extraluminal free fluid in the peritoneal cavity is also clearly visualized with this modality. However, data on the diag­nostic accuracy and prognostic value of abdominal ultrasound remain limited and frequently focus on isolated ab­normalities rather than a constellation of findings. Moreover, to date, ultrasound findings have had little to no impact on the choice of therapeutic management. For this reason, the clinical utility of abdominal ultrasound must be further clarified in additional studies before its widespread use in the diagnosis of necrotizing enterocolitis can be recom­mended.