Gerardo Fernández-Ortega, Departamento de Cirugía Pediátrica, Hospital Materno Perinatal Mónica Pretelini Sáenz, Instituto Mexicano del Seguro Social-Bienestar, Toluca, México
Gabriela del C. Morón-García, Servicio de Neonatología, Hospital de Ginecología y Obstetricia, Instituto Materno-Infantil del Estado de México, Toluca, México
Héctor A. Esparza-Silva, Departamento de Pediatría, Hospital Regional Toluca PPS, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, México
Mónica D. Martín-de Saro, Servicio de Genética, Hospital Materno-Infantil, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, México
Lautaro Plaza-Benhumea, Servicio de Genética, Hospital para el Niño de Toluca, Instituto Materno-Infantil del Estado de México, Toluca, México
Background: Necrotizing enterocolitis (NEC) remains one of the leading causes of morbidity and mortality in neonates. Ultrasound (US) has shown value in the evaluation of these patients; however, its role in guiding therapeutic decisions requires further investigation. We aimed to assess the usefulness of US in the surveillance of NEC and to identify sonographic findings associated with the need for surgery. Methods: A prospective, longitudinal, and analytical study was conducted in two perinatal hospitals between 2022 and 2023. Participants: preterm neonates with NEC stage ≥ IIa (Bell’s criteria). Serial bedside ultrasound evaluations were performed every 12-24 hours. Descriptive and inferential statistics were applied; univariate analysis and logistic regression were used to determine the association between ultrasound findings and the need for surgery, expressed as odds ratio (OR) with 95% confidence intervals (95% CI). A p value < 0.05 was considered statistically significant. Results: Thirty-four neonates were included, 12 (35.3%) required surgery. A total of 120 ultrasounds were performed (mean 3.5 per patient). Pneumoperitoneum (OR: 45; 95% CI: 2.2-895.7; p = 0.01) and decreased mural blood flow (OR: 16.6; 95% CI: 1.2- 227.7; p = 0.03) were significantly associated with surgical indication. Overall mortality was 20.6%, higher in the surgical group (33.3%). Conclusions: US is a valuable tool for assessing disease progression and guiding clinical decision-making in NEC. Findings such as reduced mural vascular flow and pneumoperitoneum are strongly associated with the need for surgery. These results support the systematic incorporation of US into the monitoring of NEC.
Keywords: Necrotizing enterocolitis. Surgery. Newborn. NICU. Abdominal ultrasound. Pediatrics.