Zvizdic Zlatan, Sefic Pasic Irmina, Dzananovic Amra, Rustempasic Nedzad, Milisic Emir, Jonuzi Asmir, Vranic Semir
Clinic of Pediatric Surgery, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
Department of Radiology, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
Children (Basel). 2020 Jan 23;7(2):9. doi: 10.3390/children7020009.
Necrotizing enterocolitis (NEC) is the most common life-threatening gastrointestinal emergency associated with prematurity. Timely diagnosis and adequate treatment are crucial to reduce the morbidity and mortality of the affected infants. The aim of this study was to evaluate the diagnostic yield of bowel dilatation on plane abdominal radiography (AR) in the early diagnosis and NEC severity in preterm infants.
We retrospectively reviewed initial ARs of 50 preterm infants with NEC ≥ stage II admitted to the neonatal intensive care unit (NICU) in a tertiary-care hospital. The largest bowel loops diameters (AD), the latero-lateral diameters of the peduncle of the first lumbar vertebra (L1), and the distance of the upper edge of the first lumbar vertebra and the lower edge of the second one, including the disc space (L1-L2), were measured. All anteroposterior ARs were done in a supine projection on the day of onset of the initial symptoms of NEC.
Preterm infants with surgical NEC showed a statistically significant increase in the AD/L1 ratio ( < 0.001) and AD/L1-L2 ratio ( < 0.001) compared with preterm infants with medical NEC. We found no significant association between the site of the most distended bowel loop and the severity of NEC ( > 0.05).
Bowel loop distension on initial AR may serve as an additional diagnostic tool in the early diagnosis and severity of stages II/III NEC. Further prospective clinical studies should validate the results from this study.
坏死性小肠结肠炎（NEC）是与早产相关的最常见的危及生命的胃肠道急症。及时诊断和充分治疗对于降低受影响婴儿的发病率和死亡率至关重要。本研究的目的是评估腹部平片（AR）上肠扩张在早产儿NEC早期诊断及病情严重程度评估中的诊断价值。
我们回顾性分析了一家三级医院新生儿重症监护病房（NICU）收治的50例NEC≥Ⅱ期早产儿的初始腹部平片。测量最大肠袢直径（AD）、第一腰椎（L1）椎弓根的左右径以及第一腰椎上缘与第二腰椎下缘之间的距离（包括椎间盘间隙，L1-L2）。所有前后位腹部平片均在NEC初始症状出现当天仰卧位时拍摄。
与内科性NEC的早产儿相比，外科性NEC的早产儿AD/L1比值（<0.001）和AD/L1-L2比值（<0.001）有统计学意义的升高。我们发现最扩张肠袢的部位与NEC严重程度之间无显著相关性（>0.05）。
初始腹部平片上的肠袢扩张可作为NECⅡ/Ⅲ期早期诊断及病情严重程度评估的辅助诊断工具。进一步的前瞻性临床研究应验证本研究结果。
