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The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.ORCID iD: 0000-0001-5176-4949
Department of Radiology, Stanford University Medical Center, Stanford, USA; Division of Diagnostic Radiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Radiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Stanford, USA.
2018 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 28, no 9, p. 3621-3631Article in journal (Refereed) Published
Abstract [en]

Objectives

To investigate current practices and perceptions of imaging in necrotising enterocolitis (NEC) according to involved specialists, put them in the context of current literature, and identify needs for further investigation.

Methods

Two hundred two neonatologists, paediatric surgeons, and radiologists answered a web-based questionnaire about imaging in NEC at their hospitals. The results were descriptively analysed, using proportion estimates with 95% confidence intervals.

Results

There was over 90% agreement on the value of imaging for confirmation of the diagnosis, surveillance, and guidance in decisions on surgery as well as on abdominal radiography as the first-choice modality and the most important radiographic signs. More variation was observed regarding some indications for surgery and the use of some ultrasonographic signs. Fifty-eight per cent stated that ultrasound was used for NEC at their hospital. Examination frequency, often once daily or more but with considerable variations, and projections used in AR were usually decided individually rather than according to fixed schedules. Predicting the need of surgery was regarded more important than formal staging.

Conclusion

Despite great agreement on the purposes of imaging in NEC and the most important radiographic signs of the disease, there was considerable diversity in routines, especially regarding examination frequency and the use of ultrasound. Apart from continuing validation of ultrasound, important objectives for future studies include definition of the supplementary roles of both imaging modalities in relation to other diagnostic parameters and evaluation of various imaging routines in relation to timing of surgery, complications, and mortality rate.

Place, publisher, year, edition, pages
Springer, 2018. Vol. 28, no 9, p. 3621-3631
Keywords [en]
Enterocolitis, necrotising, Abdominal radiography, Ultrasonography, Surveys and questionnaires, Professional practice
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:liu:diva-146094DOI: 10.1007/s00330-018-5362-xISI: 000440984300006OAI: oai:DiVA.org:liu-146094DiVA, id: diva2:1193594
Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2018-08-24
In thesis
1. Necrotising Enterocolitis: epidemiology and imaging
Open this publication in new window or tab >>Necrotising Enterocolitis: epidemiology and imaging
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Necrotising enterocolitis (NEC) is a potentially devastating intestinal inflammation of multifactorial aetiology in premature or otherwise vulnerable neonates. Because of the broad spectrum of presentations, diagnosis and timing of surgical intervention may be challenging, and imaging needs to be an integrated part of management.

The first four studies included in this thesis used routinely collected, nationwide register data to describe the incidence of NEC in Sweden 1987‒2009, its variation with time, seasonality, space-time clustering, and associations with maternal, gestational, and perinatal factors, and the risk of intestinal failure in the aftermath of the disease.

Early infant survival increased dramatically during the study period. The incidence rate of NEC was 0.34 per 1,000 live births, rising from 0.26 per 1,000 live births in the first six years of the study period to 0.57 in the last five. The incidence rates in the lowest birth weights were 100‒160 times those of the entire birth cohort. Seasonal variation was found, as well as space-time clustering in association with delivery hospitals but not with maternal residential municipalities.

Comparing NEC cases with matched controls, some factors, positively associated with NEC, were isoimmunisation, fetal distress, caesarean section, persistent ductus arteriosus, cardiac and gastrointestinal malformations, and chromosomal abnormalities. Negative associations included maternal pre-eclampsia, maternal urinary infection, and premature rupture of the membranes. Intestinal failure occurred in 6% of NEC cases and 0.4% of controls, with the highest incidence towards the end of the study period.

The last study investigated current practices and perceptions of imaging in the management of NEC, as reported by involved specialists. There was great consensus on most issues. Areas in need of further study seem mainly related to imaging routines, the use of ultrasound, and indications for surgery.

Developing alongside the progress of neonatal care, NEC is a complex, multifactorial disease, with shifting patterns of predisposing and precipitating causes, and potentially serious long-term complications. The findings of seasonal variation, spacetime clustering, and negative associations with antenatal exposure to infectious agents, fit into the growing understanding of the central role of bacteria and immunological processes in normal maturation of the intestinal canal as well as in the pathogenesis of NEC. Imaging in the management of NEC may be developed through future studies combining multiple diagnostic parameters in relation to clinical outcome.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. p. 97
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1586
National Category
Pediatrics Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-142375 (URN)10.3384/diss.diva-142375 (DOI)9789176854556 (ISBN)
Public defence
2017-11-24, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-10-30 Created: 2017-10-30 Last updated: 2018-03-27Bibliographically approved

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Ahle, Margareta

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