Management of NEC: Surgical Treatment and Role of Traditional X-ray Versus Ultrasound Imaging, Experience of a Single Centre

摘要

Introduction: Necrotizing enterocolitis is the most common cause of the postnatal criticalconditions and remains one of the dominant causes of newborns’ death in Neonatal Intensive Care.The morbidity and mortality associated with necrotizing enterocolitis remains largely unchangedand the incidence of necrotizing enterocolitis continues to increase. There is no general agreementregarding the surgical treatment of the necrotizing enterocolitis.Methods: In this paper, we want to evaluate the results obtained in our centre from different types ofnecrotizing enterocolitis’s surgical treatment and to analyse the role of traditional X-ray versus ultrasounddoppler imaging in the evolutionary phases of necrotizing enterocolitis. The study wasconducted in the Department of Emergency-Urgency NICU, A.O.R.N. Santobono-Pausilipon inNaples from January 2010 to December 2016. Patients were monitored by hematochemical examinationsand radiological orthostatic exams every 12 hours, so that they had a surgical opportunitybefore intestinal perforation occurred. Ultrasonography was performed to monitor preterm infantswho were hospitalized in NICU and that showed NEC symptomatology in phase I Bell staging.Results: They were recruited 75 premature infants with NEC symptomatology in phase I-III of Bellstaging, who underwent surgical or medical treatment. In infants with a birth weight >1500 g(N=30), laparotomy and necrotic bowel resection has generally been our preferred approach. In 46patients we practiced a primary anastomosis after resection of an isolated necrotic intestinal segment.In patients with multiple areas of necrosis and dubious intestinal vitality, were performed a'second-look' scheduled after 24 to 48 hours to re-evaluate the intestine. In the initial phase of necrotizingenterocolitis, when the radiographic examination shows only a specific dilation of theloops, ultrasonography shows more and more specific signs, as wall thickening, alteration of parietalechogenicity, increase in wall perfusion, single or sporadic airborne microbubbles in the thicknessof wall sections.Conclusions: Optimal surgical therapy for NEC begins with adequate antibiotic therapy, reintegrationof liquids but above all with timely diagnosis, aimed to discover early prodromic phases of walldamage by US, a fundamental tool. Abdomen radiography shows specificity frameworks only whenbarrier damage is detected while US provides real-time imaging of abdominal structures, highlightingsome elements that are completely excluded by radiograph.