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      Point-of-care Ultrasound to Diagnose and Monitor the Course of Necrotizing Enterocolitis

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          Abstract

          Context:

          Neonatal gut ultrasound (US) is an emerging clinical tool for quick diagnosis and prognosis in various abdominal pathologies. In this review, we summarize normal gut US findings and concentrate on the specifications of diagnosing necrotizing enterocolitis.

          Evidence:

          A comprehensive literature search was conducted across numerous sources with relevant keywords along with the specified age group of 0–28 days of life.

          Findings:

          This review describes the normal gut US picture with the basic technicalities needed to master the art of point-of-care (POC) abdominal US. This modality is gaining importance due to its accuracy, applicability, safety, and affordability. Key findings include altered bowel perfusion, decreased peristalsis, and bowel wall thickening with better precision compared to abdominal X-ray (AXR). Many meta-analyses and narrative reviews have already demonstrated their usefulness. The high specificity and positive predictive value could make this tool a guide for early identification and prompt surgical intervention in the dreaded diagnosis of necrotizing enterocolitis.

          Conclusion:

          Emerging evidence and expertise in the field of abdominal US will make it a valuable tool for early diagnosis and prognosis of necrotizing enterocolitis.

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          Most cited references37

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          Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging.

          A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.
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            Necrotizing Enterocolitis: Treatment Based on Staging Criteria

            Neonatal necrotizing enterocolitis is the most important cause of acquired gastrointestinal morbidity or mortality among low birthweight infants. Prematurity alone is probably the only identifiable risk factor. Although the etiology is unknown NEC has many similarities to an infectious disease. Proper staging helps improve reporting and the management of NEC.
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              Late-Onset Sepsis in Very Low Birth Weight Neonates: The Experience of the NICHD Neonatal Research Network

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                Author and article information

                Journal
                9918418384706676
                51742
                Newborn (Clarksville)
                Newborn (Clarksville)
                Newborn (Clarksville, Md.)
                2769-514X
                14 October 2023
                Jul-Sep 2023
                26 September 2023
                15 November 2023
                : 2
                : 3
                : 203-213
                Affiliations
                [1 ]Department of Neonatology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
                [2 ]Department of Neonatology, Gupta Neonatal Hospital, Hisar, Haryana, India
                [3 ]Department of Pediatrics and Neonatology, Mercy Hospital, Nagaon, Assam, India
                [4 ]Department of Pediatrics, Louisville State University, Shreveport, Louisville
                [5 ]Global Newborn Society ( https://www.globalnewbornsociety.org/)
                [6 ]Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
                Author notes
                Corresponding Author: Pradeep Suryawanshi, Global Newborn Society ( https://www.globalnewbornsociety.org/); Department of Neonatology, Bharati Vidyapeeth (Deemed to be University) Medical College, Hospital, and Research Center, Pune, Maharashtra, India, Phone: +91 9923540500, drpradeepsuryawanshi@ 123456gmail.com
                Article
                NIHMS1935670
                10.5005/jp-journals-11002-0070
                10653205
                37974931
                1380ffb0-045f-46d6-87ed-580409324cd1

                This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Categories
                Article

                gut signature,necrotizing enterocolitis,point-of-care abdominal ultrasound

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