Prognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age ☆ Aurélie Garbi-Goutel a, ⁎, Véronique Brévaut-Malaty a , Michel Panuel b , Fabrice Michel c , Thierry Merrot d , Catherine Gire e a Service de médecine néonatale, unité de soins intensifs néonatale, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Chemin des Bourrellys, 13015 Marseille Cedex 20, France b Département d’imagerie médicale, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Chemin des Bourrellys, 13015 Marseille Cedex 20, France c Service d’anesthésie et de réanimation pédiatrique, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France d Service de chirurgie pédiatrique, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Chemin des Bourrellys, 13015 Marseille Cedex 20, France e Service de médecine néonatale, unité de soins intensifs néonatale, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Chemin des Bourrellys, 13015 Marseille Cedex 20, France abstract article info Article history: Received 15 April 2013 Received in revised form 1 October 2013 Accepted 12 November 2013 Key words: Necrotizing enterocolitis Sonography Preterm infant Prognosis Objective: The purpose of this study was to assess the prognostic value of abdominal sonography in necrotizing enterocolitis (NEC) in preterm infants with a gestational age less than 33 weeks of gestation, using surgery and/or death as the primary outcome and stenosis as the secondary outcome. Methods: A retrospective study of 95 premature infants (mean gestational age: 28.6 weeks), presenting with NEC between January 2009 and November 2011 and who underwent plain abdominal radiography and sonography, was performed. In uni- and multivariate analyses, radiographic and sonographic findings were correlated with complications (‘surgery and/or death’ and ‘stenosis’). Results: Sonographic findings of free intraperitoneal air (odd ratio [OR] = 8.0; IC, 1.4–44.2), free abdominal fluid (OR 3.5; IC 1.3–9.4), portal venous gas (OR 3.9; IC, 1.2–12.9), and bowel wall thickening (OR 2.8; IC,1.1–7.2) were significantly associated with surgery and/or death. Intramural gas was significantly correlated (OR = 11.8; IC, 1.5–95.8) with intestinal stenosis following NEC. None of the radiographic findings were associated with complications. Conclusion: Abdominal sonography is a reliable tool for the prognostic assessment of NEC in preterm infants. © 2014 Elsevier Inc. All rights reserved. Necrotizing enterocolitis (NEC) is a leading cause of morbidity in neonatal intensive care units (NICU). The rate of confirmed NEC varies between 5% and 10% in infants weighing less than 1500 g, with an associated mortality rate of 20%–30%, and up to 50% when surgery is necessary [1–4]. Diagnosis of NEC is based on the presence of nonspecific gastro- intestinal clinical signs (feeding intolerance, abdominal distension, and bloody stools) in conjunction with at least one pathognomonic sign on plain abdominal radiography (intramural gas or portal venous gas) [2]. Bell’s classification of NEC, which was modified by Walsh and Kliegman in 1986, relates to the worsening of these clinical and radiological abdominal signs [5,6]. These staging criteria help pedia- tricians in the diagnosis, management, and prognostic assessment of NEC, but they are exclusively based on plain abdominal radiogra- phy, which remains the “gold standard” for the diagnostic assessment [2]. Nevertheless, the adverse prognostic value of certain radiological signs is currently debatable [7–11]. The usefulness of abdominal sonography in the diagnosis of NEC, known since 1984 [12], was only studied in small case series and heterogeneous gestational age populations [12–20]. This imaging modality allows for an earlier detection of typical NEC signs [17,19– 21], with more rapid disease management. However, few studies have investigated the correlation between NEC sonographic signs and patient outcomes [13]. The main objective of our study was to assess the prognostic value of abdominal ultrasound in premature infants with NEC, who were born before 33 weeks of gestational age. The primary outcome was surgery and/or death, and the secondary outcome occurrence of post- NEC stenosis. 1. Patients and methods This was a single-center, retrospective study conducted in a Level 3 university maternity unit. 1.1. Inclusion and exclusion criteria Inclusion criteria: premature infant of less than 33 weeks gesta- tional age, born between January 1, 2009 and November 30, 2011, and Journal of Pediatric Surgery 49 (2014) 508–513 ☆ Conflict of interest: We have no conflict of interest in relation to this study. ⁎ Corresponding author. Tel.: +33 4 91 96 87 50; fax: +33 4 91 96 46 75. E-mail address: aurelie.garbi@ap-hm.fr (A. Garbi-Goutel). 0022-3468/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpedsurg.2013.11.057 Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg