Maarten Janssen Lok1,2, Hiromu Miyake2, Alison Hock2, Alan Daneman3, Agostino Pierro4, Martin Offringa5. 1. Division of Pediatric Surgery, Amalia Children's Hospital Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. 2. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Avenue, Toronto, ON, M5G 1X8, Canada. 3. Division of Radiology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. 4. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Avenue, Toronto, ON, M5G 1X8, Canada. Agostino.Pierro@sickkids.ca. 5. Division of Neonatology and Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, University of Toronto, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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