A role for abdominal ultrasound in discriminating suspected necrotizing enterocolitis in congenital heart disease patients

Purpose We evaluated the diagnostic utility of abdominal ultrasound (AUS), an adjunct to abdominal X-ray (AXR), for necrotizing enterocolitis (NEC) in congenital heart disease (CHD) patients. Methods 86 patients with suspected NEC from 2009 to 2018 were classified as with CHD ( n = 18) if they required cardiac intervention versus without CHD ( n = 68). Clinical and radiological data were collected, including AXR and AUS concordance. Wilcoxon rank-sum test and Fisher’s exact test were performed. Results CHD patients had higher birth weights ( p < 0.001) and gestational ages ( p < 0.001) than non-CHD patients. CHD patients presented more frequently with hypotension ( p = 0.041) and less frequently with bilious emesis ( p < 0.001). Overall, CHD patients were less likely to have AUS findings of pneumatosis (33.3 vs. 72.1%; p = 0.005) and decreased mural flow (0 vs. 20.6%; p = 0.035) compared to non-CHD patients. On concordance analysis, CHD patients had 3.9-fold more discordant studies with pneumatosis on AXR but not on AUS (33.3 vs. 8.8%; p = 0.016) compared to non-CHD patients. Urgent surgery was required in 5.6% of CHD patients versus 16.2% of non-CHD patients. Conclusion CHD patients with suspected NEC represent a distinct clinical population. AUS has particular utility in assessing findings of bowel viability in the CHD NEC population, reflecting reduced rates of surgical NEC.