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Article

Clinical Outcome of Ultrasound-Detected Perforated Necrotizing Enterocolitis without Radiographic Pneumoperitoneum in Very Preterm Infants

by
Myoung Kyoung Kim
1,
Tae Yeon Jeon
1,*,†,
Kyunga Kim
2,
Yu Jin Kim
1,
So-Young Yoo
1,
Ji Hye Kim
1,
Yun Sil Chang
3,
Sanghoon Lee
4,
Jeong-Meen Seo
4 and
Sung-Hoon Moon
5,*,†
1
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
2
Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
3
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
4
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
5
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2023, 12(5), 1805; https://doi.org/10.3390/jcm12051805
Submission received: 19 November 2022 / Revised: 14 February 2023 / Accepted: 22 February 2023 / Published: 23 February 2023
(This article belongs to the Section Nuclear Medicine & Radiology)
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Abstract

Objectives: To investigate the clinical outcomes of ultrasound (US)-detected perforated necrotizing enterocolitis (NEC) without radiographic pneumoperitoneum in very preterm infants. Methods: In this single-center retrospective study, very preterm infants who underwent a laparotomy for perforated NEC during their neonatal intensive care unit stay were classified into two groups according to the absence or presence of pneumoperitoneum on radiographs (the case versus the control groups). The primary outcome was death before discharge, and the secondary outcomes included major morbidities and body weight at 36 weeks postmenstrual age (PMA). Results: Of the 57 infants with perforated NEC, 12 (21%) had no pneumoperitoneum on the radiographs and were diagnosed with perforated NEC on the US. In the multivariable analyses, the primary outcome of death before discharge was significantly lower in infants with perforated NEC without radiographic pneumoperitoneum than in those with perforated NEC and radiographic pneumoperitoneum (8% [1/12] vs. 44% [20/45]; adjusted odds ratio [OR], 0.02; 95% confidence interval [CI], 0.00–0.61; p = 0.025). The secondary outcomes (short bowel syndrome, total parenteral nutrition dependence for 3 months or more, the length of their hospital stay, a bowel stricture requiring surgery, sepsis after the laparotomy, acute kidney injury after the laparotomy, and body weight at 36 weeks PMA) did not differ significantly between the two groups. Conclusions: Very preterm infants with US-detected perforated NEC without radiographic pneumoperitoneum had a lower risk of death before discharge than those with perforated NEC and radiographic pneumoperitoneum. Bowel USs may have a potential role in surgical decision-making in infants with advanced NEC.
Keywords: enterocolitis; necrotizing; infant; extremely premature; ultrasonography; pneumoperitoneum enterocolitis; necrotizing; infant; extremely premature; ultrasonography; pneumoperitoneum

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MDPI and ACS Style

Kim, M.K.; Jeon, T.Y.; Kim, K.; Kim, Y.J.; Yoo, S.-Y.; Kim, J.H.; Chang, Y.S.; Lee, S.; Seo, J.-M.; Moon, S.-H. Clinical Outcome of Ultrasound-Detected Perforated Necrotizing Enterocolitis without Radiographic Pneumoperitoneum in Very Preterm Infants. J. Clin. Med. 2023, 12, 1805. https://doi.org/10.3390/jcm12051805

AMA Style

Kim MK, Jeon TY, Kim K, Kim YJ, Yoo S-Y, Kim JH, Chang YS, Lee S, Seo J-M, Moon S-H. Clinical Outcome of Ultrasound-Detected Perforated Necrotizing Enterocolitis without Radiographic Pneumoperitoneum in Very Preterm Infants. Journal of Clinical Medicine. 2023; 12(5):1805. https://doi.org/10.3390/jcm12051805

Chicago/Turabian Style

Kim, Myoung Kyoung, Tae Yeon Jeon, Kyunga Kim, Yu Jin Kim, So-Young Yoo, Ji Hye Kim, Yun Sil Chang, Sanghoon Lee, Jeong-Meen Seo, and Sung-Hoon Moon. 2023. "Clinical Outcome of Ultrasound-Detected Perforated Necrotizing Enterocolitis without Radiographic Pneumoperitoneum in Very Preterm Infants" Journal of Clinical Medicine 12, no. 5: 1805. https://doi.org/10.3390/jcm12051805

APA Style

Kim, M. K., Jeon, T. Y., Kim, K., Kim, Y. J., Yoo, S.-Y., Kim, J. H., Chang, Y. S., Lee, S., Seo, J.-M., & Moon, S.-H. (2023). Clinical Outcome of Ultrasound-Detected Perforated Necrotizing Enterocolitis without Radiographic Pneumoperitoneum in Very Preterm Infants. Journal of Clinical Medicine, 12(5), 1805. https://doi.org/10.3390/jcm12051805

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