Schneeman Libby,  Khwaja Asef,  Bloom Glenn,  Otero Hansel

Final Pr. ID: Poster #: EDU-004 (T)

Ultrasound has become a powerful tool for the evaluation of bowel pathology in the children. In the newborn, ultrasound (US) can be used to diagnose, stage, and follow up necrotizing enterocolitis (NEC) and its complication. US has excellent sensitivity and specificity for the identification of bowel wall thickening, peristalsis, pneumatosis, portal venous gas and free air and has become an integral evaluation tool for the newborn with abdominal distention. Our educational poster will:
1. Summarize proper US equipment, technique and protocol for diagnosing and following up NEC
2. Discuss advantages and benefits of incorporating US in the evaluation of bowel in newborns
3. Illustrate the sonographic findings of mild, moderate and severe NEC through cases Read More

Authors:  Schneeman Libby , Khwaja Asef , Bloom Glenn , Otero Hansel

Keywords:  Necrotizing Enterocolitis, Newborn, Ultrasound

Durand Rachelle,  Francavilla Michael,  Edgar Christopher,  Maya Carolina,  Kaplan Summer

Final Pr. ID: Poster #: SCI-019

Although ultrasound has advantages for bowel assessment in infants, the majority of bowel evaluation still takes place by radiograph. Although radiographic signs of advanced necrotizing enterocolitis (NEC) have been well documented, there is poor understanding of gas patterns in less severe NEC or other causes of feeding intolerance. Progressively abnormal appearance of gas patterns in NEC has been described, but it is unclear what role a gastric sump plays. Because a sump decompresses bowel and changes the gas pattern, its role in the progression of abnormal bowel gas patterns warrants attention. Read More

Authors:  Durand Rachelle , Francavilla Michael , Edgar Christopher , Maya Carolina , Kaplan Summer

Keywords:  necrotizing enterocolitis, NEC, bowel

Poletto Erica,  Richards Matthew,  Goldwasser Bernard,  Meckmongkol Teerin,  Ciullo Sean,  Prasad Rajeev

Final Pr. ID: Poster #: SCI-012

The formation of one or more intestinal strictures is a known complication of necrotizing enterocolitis (NEC). Multiple prior investigations have found that the occurrence of colonic strictures is higher than small intestinal strictures, at an approximate ratio of 2-3:1. We hypothesized that small intestinal strictures may be more prevalent than colonic strictures at our urban, academic, tertiary care children’s hospital.

Our first aim was to determine the incidence of small intestinal and colonic strictures in patients with prior medically treated NEC who had not undergone previous surgical intervention. Second, we attempted to evaluate for differences in demographics and other clinical variables between the group of patients with small intestinal strictures versus the group with colonic strictures. Read More

Authors:  Poletto Erica , Richards Matthew , Goldwasser Bernard , Meckmongkol Teerin , Ciullo Sean , Prasad Rajeev

Keywords:  necrotizing enterocolitis, stricture

Oliva Vanesa,  Veiga-canuto Diana,  Gerrie Samantha

Final Pr. ID: Poster #: EDU-032

Necrotizing enterocolitis (NEC) is the most common gastrointestinal complication in neonates, particularly in preterm infants. Despite advances in neonatal diagnostic and clinical management, the mortality rate remains high at 20-67%, depending on birth weight and the presence of perforation.
The use of ultrasound (US) in the imaging workup of NEC is well established with important roles in predicting outcome. In particular, Doppler US has shown higher sensitivity and specificity than abdominal radiographs for detecting necrotic bowel. In addition, US is a cost-effective bedside modality that avoids ionizing radiation, making it particularly advantageous in neonates. However, there are several technical challenges that can hinder optimal image acquisition and interpretation including a large amount of intraluminal bowel gas, patients on mechanical ventilation and patients with cardiovascular compromise. We discuss these technical challenges, review common pitfalls and provide a problem-solving approach to improve the diagnostic utility of US in managing these patients.
A large amount of intraluminal bowel gas limits the assessment of the bowel wall making it more difficult to identify intramural gas and changes in bowel perfusion. Increasing transducer pressure can help by displacing intraluminal gas from the field of view, however, in some patients it is not possible due to persistent oxygen desaturations or abdominal discomfort.
Doppler assessment of bowel perfusion can be particularly difficult in mechanically ventilated patients due to motion artifacts caused by transmitted vibration. In patients with low cardiac output and/or receiving vasopressor therapy, color Doppler signal may be difficult to detect due to reduced bowel perfusion; adjusting US parameters may improve bowel wall perfusion assessment.
One imaging pitfall is misinterpreting the presence of pneumatosis as intraluminal gas trapped within the stool or as bowel wall edema. It is important to recognize that intramural gas will not change position with peristalsis, respiratory movement, patient repositioning, or abdominal compression with the transducer.
Recognizing these technical limitations is essential for accurate interpretation, standardized protocol development, and reliable use of US in the management of NEC.
Furthermore, emerging techniques, such as contrast-enhanced US may help address several of these technical limitations, particularly in the evaluation of bowel perfusion. Read More

Authors:  Oliva Vanesa , Veiga-canuto Diana , Gerrie Samantha

Keywords:  Necrotizing Enterocolitis, Ultrasound, Pitfalls

Ulikowska Ewelina

Final Pr. ID: Poster #: EDU-005 (T)

Necrotizing enterocolitis (NEC) is one of the most leading causes of morbidity and mortality in premature infants. It usually develops within the first days following birth. NEC is a gastrointestinal disease, that can affect any part of the large or small bowel but most commonly affects the terminal ileum and colon. It causes inflammation and tissue death of the affected area and can lead to bowel perforations and a need for surgical resections. In severe cases, bacteria and waste products can pass through the perforated intestine and enter the baby’s bloodstream or abdominal cavity which can cause a life threatening infection and shock. In a pediatric hospital, that treats premature infants, signs and symptoms of necrotizing enterocolitis are very important to diagnose quickly. Most common symptoms include poor feeds, bloating or swelling in the abdomen, bloody stools and diarrhea. In order to manage the disease medically and surgically, prompt diagnostic tests such as ultrasounds and xrays need to be performed. Abdominal X-rays are the gold standard of diagnosis and treatment planning. Therefore it is crucial, to recognize the radiographic signs of NEC. The purpose of this abstract is to describe radiographic appearances associated with NEC, which include: dilated bowel loops, thickened bowel walls with edema, pneumatosis intestinalis, abdominal free air, portal venous gas, absence of bowel gas. I will present confirmed cases that show radiographic signs of NEC. Read More

Authors:  Ulikowska Ewelina

Keywords:  Necrotizing Enterocolitis, Radiographic findings