Janssen Lok Maarten, Miyake Hiromu, Hock Alison, Daneman Alan, Pierro Agostino, Offringa Martin
Division of Pediatric Surgery, Amalia Children's Hospital Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Pediatr Surg Int. 2018 Jun;34(6):589-612. doi: 10.1007/s00383-018-4259-8. Epub 2018 May 2.
Necrotizing enterocolitis (NEC) remains a life-threatening disease among infants in the NICU. Early diagnosis and careful monitoring are essential to improve outcomes. Abdominal ultrasound (AUS) seems a promising addition to current diagnostic modalities, but its clinical utility is uncertain. The aim of this study was to identify AUS features associated with definite NEC (i.e. Bell stage ≥ II), failed medical treatment, surgery, and death.
Embase, MEDLINE, Web of Science and CINAHL databases were searched for studies that addressed any NEC-related AUS feature in relation to any of the four outcomes. After critical appraisal of relevant study methods, meta-analyses were conducted using a random-effect model.
15 out of 1215 studies were included. All AUS features had sensitivities below 70% and specificities largely above 80% for diagnosing definite NEC; several AUS features were significantly associated with failed medical treatment and surgery. Substantial heterogeneity, poor reporting quality and uncertain risk of bias were found.
While clear associations of AUS features with failed medical treatment exist and AUS may detect definite NEC, substantial heterogeneity, poor reporting quality and an uncertain risk of bias impair the use of AUS for clinical decision making. A prospective, well-designed validation study is needed.
坏死性小肠结肠炎（NEC）仍是新生儿重症监护病房（NICU）中威胁婴儿生命的疾病。早期诊断和仔细监测对于改善预后至关重要。腹部超声（AUS）似乎是当前诊断方法的一个有前景的补充，但其实用性尚不确定。本研究的目的是确定与明确的NEC（即贝尔分期≥II期）、治疗失败、手术及死亡相关的AUS特征。
检索Embase、MEDLINE、科学网和护理学与健康领域数据库，查找涉及任何与四种结局之一相关的NEC相关AUS特征的研究。在对相关研究方法进行严格评估后，采用随机效应模型进行荟萃分析。
1215项研究中有15项被纳入。所有AUS特征在诊断明确的NEC时敏感性均低于70%，特异性大多高于80%；一些AUS特征与治疗失败和手术显著相关。发现存在显著异质性、报告质量差和偏倚风险不确定。
虽然AUS特征与治疗失败存在明确关联，且AUS可能检测出明确的NEC，但显著的异质性、报告质量差和不确定的偏倚风险妨碍了AUS在临床决策中的应用。需要进行一项前瞻性、设计良好的验证研究。
