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Necrotizing Enterocolitis
Hank Baskin, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Necrotizing enterocolitis (NEC): Poorly understood but life-threatening condition of neonatal GI tract characterized by inflammation, ischemia, & translocation of bacteria into bowel wall
          • Very low birth weight (VLBW): < 1,500 g
          • Extremely low birth weight (ELBW): < 1,000 g

        IMAGING

        • General Features

          • Radiographic Findings

            • Ultrasonographic Findings

              • Fluoroscopic Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Gokli A et al: Contrast-enhanced ultrasound of the pediatric bowel. Pediatr Radiol. ePub, 2021
                                        2. Lazow SP et al: Abdominal ultrasound findings contribute to a multivariable predictive risk score for surgical necrotizing enterocolitis: a pilot study. Am J Surg. ePub, 2021
                                        3. Neu J: Necrotizing enterocolitis: a multi-omic approach and the role of the microbiome. Dig Dis Sci. 65(3):789-96, 2020
                                        4. Pammi M et al: Recent advances in necrotizing enterocolitis research: strategies for implementation in clinical practice. Clin Perinatol. 47(2):383-97, 2020
                                        5. Alganabi M et al: Recent advances in understanding necrotizing enterocolitis. F1000Res. 8, 2019
                                        6. Bazacliu C et al: Pathophysiology of necrotizing enterocolitis: An Update. Curr Pediatr Rev. 15(2):68-87, 2019
                                        7. Chen S et al: Application of abdominal sonography in diagnosis of infants with necrotizing enterocolitis. Medicine (Baltimore). 98(28):e16202, 2019
                                        8. De Bernardo G et al: Management of NEC: surgical treatment and role of traditional x-ray versus ultrasound imaging, experience of a single centre. Curr Pediatr Rev. 15(2):125-30, 2019
                                        9. Kim JH: Role of Abdominal US in diagnosis of NEC. Clin Perinatol. 46(1):119-27, 2019
                                        10. Overman RE Jr et al: Necrotizing enterocolitis in term neonates: a different disease process? J Pediatr Surg. 54(6):1143-6, 2019
                                        11. Ahle M et al: The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature. Eur Radiol. 28(9):3621-31, 2018
                                        12. Chen S et al: Comparison of abdominal radiographs and sonography in prognostic prediction of infants with necrotizing enterocolitis. Pediatr Surg Int. 34(5):535-41, 2018
                                        13. Cuna AC et al: Bowel ultrasound for the diagnosis of necrotizing enterocolitis: a meta-analysis. Ultrasound Q. 34(3):113-8, 2018
                                        14. Cuna AC et al: Bowel ultrasound for predicting surgical management of necrotizing enterocolitis: a systematic review and meta-analysis. Pediatr Radiol. 48(5):658-66, 2018
                                        15. Faingold R: Technical aspects of abdominal ultrasound and color Doppler assessment of bowel viability in necrotizing enterocolitis. Pediatr Radiol. 48(5):617-9, 2018
                                        16. Hackam DJ et al: New insights into necrotizing enterocolitis: from laboratory observation to personalized prevention and treatment. J Pediatr Surg. ePub, 2018
                                        17. Aliev MM et al: Advantages of abdominal ultrasound in the management of infants with necrotizing enterocolitis. Pediatr Surg Int. 33(2):213-6, 2017
                                        18. Eaton S et al: Current research on the epidemiology, pathogenesis, and management of necrotizing enterocolitis. Neonatology. 111(4):423-30, 2017
                                        19. Esposito F et al: Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quant Imaging Med Surg. 7(3):336-44, 2017
                                        20. Fonseca EKUN et al: "Zebra pattern" in necrotizing enterocolitis. Abdom Radiol (NY). 42(11):2776-7, 2017
                                        21. Juhl SM: Necrotizing enterocolitis - classification and two initial steps towards prevention. Dan Med J. 64(6), 2017
                                        22. Palleri E et al: Complex fluid collection on abdominal ultrasound indicates need for surgery in neonates with necrotizing enterocolitis. Eur J Pediatr Surg. 27(2):161-5, 2017
                                        23. Rich BS et al: Necrotizing enterocolitis. Pediatr Rev. 38(12):552-9, 2017
                                        24. He Y et al: Ultrasonography and radiography findings predicted the need for surgery in patients with necrotising enterocolitis without pneumoperitoneum. Acta Paediatr. 105(4):e151-5, 2016
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Definitions

                                                • Necrotizing enterocolitis (NEC): Poorly understood but life-threatening condition of neonatal GI tract characterized by inflammation, ischemia, & translocation of bacteria into bowel wall
                                                • Very low birth weight (VLBW): < 1,500 g
                                                • Extremely low birth weight (ELBW): < 1,000 g

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • Ultrasonographic Findings

                                                    • Fluoroscopic Findings

                                                      • CT Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Gokli A et al: Contrast-enhanced ultrasound of the pediatric bowel. Pediatr Radiol. ePub, 2021
                                                                              2. Lazow SP et al: Abdominal ultrasound findings contribute to a multivariable predictive risk score for surgical necrotizing enterocolitis: a pilot study. Am J Surg. ePub, 2021
                                                                              3. Neu J: Necrotizing enterocolitis: a multi-omic approach and the role of the microbiome. Dig Dis Sci. 65(3):789-96, 2020
                                                                              4. Pammi M et al: Recent advances in necrotizing enterocolitis research: strategies for implementation in clinical practice. Clin Perinatol. 47(2):383-97, 2020
                                                                              5. Alganabi M et al: Recent advances in understanding necrotizing enterocolitis. F1000Res. 8, 2019
                                                                              6. Bazacliu C et al: Pathophysiology of necrotizing enterocolitis: An Update. Curr Pediatr Rev. 15(2):68-87, 2019
                                                                              7. Chen S et al: Application of abdominal sonography in diagnosis of infants with necrotizing enterocolitis. Medicine (Baltimore). 98(28):e16202, 2019
                                                                              8. De Bernardo G et al: Management of NEC: surgical treatment and role of traditional x-ray versus ultrasound imaging, experience of a single centre. Curr Pediatr Rev. 15(2):125-30, 2019
                                                                              9. Kim JH: Role of Abdominal US in diagnosis of NEC. Clin Perinatol. 46(1):119-27, 2019
                                                                              10. Overman RE Jr et al: Necrotizing enterocolitis in term neonates: a different disease process? J Pediatr Surg. 54(6):1143-6, 2019
                                                                              11. Ahle M et al: The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature. Eur Radiol. 28(9):3621-31, 2018
                                                                              12. Chen S et al: Comparison of abdominal radiographs and sonography in prognostic prediction of infants with necrotizing enterocolitis. Pediatr Surg Int. 34(5):535-41, 2018
                                                                              13. Cuna AC et al: Bowel ultrasound for the diagnosis of necrotizing enterocolitis: a meta-analysis. Ultrasound Q. 34(3):113-8, 2018
                                                                              14. Cuna AC et al: Bowel ultrasound for predicting surgical management of necrotizing enterocolitis: a systematic review and meta-analysis. Pediatr Radiol. 48(5):658-66, 2018
                                                                              15. Faingold R: Technical aspects of abdominal ultrasound and color Doppler assessment of bowel viability in necrotizing enterocolitis. Pediatr Radiol. 48(5):617-9, 2018
                                                                              16. Hackam DJ et al: New insights into necrotizing enterocolitis: from laboratory observation to personalized prevention and treatment. J Pediatr Surg. ePub, 2018
                                                                              17. Aliev MM et al: Advantages of abdominal ultrasound in the management of infants with necrotizing enterocolitis. Pediatr Surg Int. 33(2):213-6, 2017
                                                                              18. Eaton S et al: Current research on the epidemiology, pathogenesis, and management of necrotizing enterocolitis. Neonatology. 111(4):423-30, 2017
                                                                              19. Esposito F et al: Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quant Imaging Med Surg. 7(3):336-44, 2017
                                                                              20. Fonseca EKUN et al: "Zebra pattern" in necrotizing enterocolitis. Abdom Radiol (NY). 42(11):2776-7, 2017
                                                                              21. Juhl SM: Necrotizing enterocolitis - classification and two initial steps towards prevention. Dan Med J. 64(6), 2017
                                                                              22. Palleri E et al: Complex fluid collection on abdominal ultrasound indicates need for surgery in neonates with necrotizing enterocolitis. Eur J Pediatr Surg. 27(2):161-5, 2017
                                                                              23. Rich BS et al: Necrotizing enterocolitis. Pediatr Rev. 38(12):552-9, 2017
                                                                              24. He Y et al: Ultrasonography and radiography findings predicted the need for surgery in patients with necrotising enterocolitis without pneumoperitoneum. Acta Paediatr. 105(4):e151-5, 2016