Comparison of abdominal radiographs and sonography in prognostic prediction of infants with necrotizing enterocolitis

The purpose of this study was to investigate the comparison of AR and AUS in predicting prognosis in infants with necrotizing enterocolitis. All patients were diagnosed as NEC at the department of general surgery and neonatal surgery, Qilu children's hospital between 1st, Jun, 2010 and 30th, Dec, 2016. The logistic regression analysis and the area under ROC curve (AUC)s were also used to compare the prognostic values of radiograph and sonograph for NEC. Throughout the study period, 86 preterm neonates were hospitalized with diagnosis of definite NEC. Among these patients, 39 infants (45.3%) required surgical treatment. After adjusting for competing sonographic factors, we identified that thick bowel wall (more than 2.5 mm) (p = 0.001, HR: 1.849), intramural gas (pneumatosis intestinalis) (p = 0.017, HR: 1.265), portal venous gas (p = 0.002, HR: 1.824), and reduced peristalsis (p = 0.021, HR: 1.544) were independent prognostic factors associated with NEC. After adjusting for competing radiographic factors, we identified that free peritoneal gas (p = 0.007, HR: 1.472), portal venous gas (p = 0.012, HR: 1.649), and dilatation and elongation (p = 0.025, HR: 1.327). Moreover, we found that the AUROC for AR logistic model was 0.745 (95% CI 0.629-0.812), which was significant lower than the AUS logistic model (AUROC: 0.857, 95% CI 0.802-0.946) for predicting prognosis of NEC. In conclusion, we found that several radiographic and sonographic parameters were associated with the prognosis of patients with NEC. The AUS model based on the logistic regression analysis was significant superior to the AR model in the prognostic prediction of NEC.