Abstract OBJECTIVE: This study was conducted to determine the value of the radiographic assessment scale in the diagnosis of neonatal necrotizing enterocolitis, and as measured by need for surgery. METHODS: A total of 61 neonates were classified into three groups according to the Bell′s Staging Criteria: NECⅠ(n=25), NECⅡ(n=11) and NEC Ⅲ(n=25). Data on gestational age at birth, gender, birth weight, clinical manifestations, treatment and prognosis of the patients were collected. Radiographic assessment scale scores were evaluated by a pediatric radiologist. RESULTS: Radiographic assessment scale scores in the NECⅠ, NECⅡand NEC Ⅲ groups were 3.2±1.4, 5.3±1.7 and 8.9±1.7, respectively (P0.05). Radiographic assessment scale scores in neonates with intestinal perforation (9.6±1.1) were higher than in those with intestinal necrosis (6.8±1.8) (P<0.05). The majority of patients (80%) who underwent operation had radiographic assessment scale scores above 7. The effective rate was 96% and 64% respectively in the NECⅠand the NECⅡ groups. Of the children in the NECⅢ group, the cure rate was 71% in the operative group, and the effective rate was 9% in the non-operative group. CONCLUSIONS: The radiographic assessment scale may be used to evaluate the severity of disease in neonates with NEC. Patients with a score on the radiographic assessment scale above 7 have indications for surgical intervention and have better short-term treatment response rates.
[2]Holman RC, Stoll BJ, Clarke MJ, Glass RI. The epidemiology of necrotizing enterocolitis infant mortality in the United States[J]. Am J Public Health, 1997, 87(12): 2026-2031.
[3]Faingold R, Daneman A, Tomlinson G, Babyn PS, Manson DE, Mohanta A, et al. Necrotizing enterocolitis: assessment of bowel viability with colour doppler US[J]. Radiology, 2005, 235(2): 587-594.
[4]Patton WL, Willmann JK, Lutz AM, Rencken IO, Gooding CA. Worsening enterocolitis in neonates: diagnosis by CT examination of urine after enteral administration of iohexol[J]. Pediatr Radiol, 1999, 29(2): 95-99.
[5]Maalouf EF, Fagbemi AF, Duggan PJ, Jayanthi S, Counsell SJ, Lewis HJ, et al. Magnetic resonance imaging of intestinal necrosis in preterm infants[J]. Pediatrics, 2000, 105(3 Pt 1): 510-514.
[6]Coursey CA, Hollingsworth CL, Gaca AM, Maxfield C, DeLong D, Bisset G 3rd. Radiologists' agreement when using a 10-point scale to report abdominal radiographic findings of necrotizing enterocolitis in neonates and infants[J]. AJR Am J Roentgenol, 2008, 191(1): 190-197.
[7]Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging[J]. Ann Surg, 1978, 187(1):1-7.
[9]Henry MC, Lawrence Moss R. Surgical therapy for necrotizing enterocolitis: bringing evidence to the bedside[J]. Semin Pediatr Surg, 2005, 14(3): 181-190.
[10]Eltayeb AA, Mostafa MM, Ibrahim NH, Eltayeb AA. The role of surgery in management of necrotizing enterocolitis[J]. Int J Surg, 2010, 8(6): 458-461.
[11]Tam AL, Camberos A, Applebaum H. Surgical decision making in necrotizing enterocolitis and focal intestinal perforation: predictive values of radiologic findings[J]. J Pediatr Surg, 2002, 37(12): 1688-1691.
[12]Bell RS, Graham CB, Stevenson JK. Roentgenologic and clinical manifestations of neonatal necrotizing enterocolitis. Experience with 43 cases[J]. Am J Roentgend Radium Ther Nucl Med, 1971, 112(1): 123-134.