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AI models show moderate sensitivity of 0.78 and specificity of 0.84 for diagnosing necrotizing enterocolitisArtificial intelligence helps identify necrotizing enterocolitis in premature infants

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Key Takeaway
Consider AI-based radiograph interpretation as a decision-support tool rather than a standalone test for necrotizing enterocolitis.

This systematic review and meta-analysis evaluates the diagnostic performance of AI-based models, specifically convolutional neural networks, for identifying necrotizing enterocolitis (NEC) in neonates from abdominal radiographs. The analysis synthesized data to determine how effectively these algorithms can assist in clinical diagnosis.

The primary finding indicates that AI-based models achieve a sensitivity of 0.78 (95% CI 0.67-0.85) and a specificity of 0.84 (95% CI 0.73-0.91). The reported positive likelihood ratio is 4.84, while the negative likelihood ratio is 0.27. These metrics suggest that AI models provide moderate diagnostic accuracy for identifying NEC in premature and very low birth weight neonates.

The authors note significant limitations, including substantial heterogeneity among the included studies and limited external validation of the underlying models. Due to these factors, the evidence is not sufficient to recommend AI as a standalone diagnostic tool. Clinical utility is currently framed as a potential decision-support adjunct rather than a primary replacement for clinical judgment.

How this fits prior evidence

This meta-analysis addresses a gap in technological tools for managing necrotizing enterocolitis (NEC). While prior coverage noted higher NEC rates with certain commercial preterm formulas and the impact of pRBC transfusion on NEC deterioration, this study focuses on diagnostic accuracy. It provides evidence on how AI-based models can assist in identifying the condition early.

When a premature baby develops necrotizing enterocolitis (NEC), it is a medical emergency. This serious intestinal infection requires fast and accurate diagnosis to keep the infant safe. Because every minute counts, doctors are looking for better ways to spot the signs of infection early on.

Researchers looked at how AI models, specifically those using convolutional neural networks, perform when reading abdominal X-rays. The analysis found that these AI tools have moderate accuracy in identifying NEC. Specifically, the models showed a sensitivity of 0.78 and a specificity of 0.84. This means they can be useful for helping doctors make decisions.

While the results are promising, there are important notes to keep in mind. The study noted significant differences between the various studies included, and the AI tools have not been tested widely enough to stand alone. Currently, these AI models are seen as helpful extra tools to support a doctor's judgment rather than a replacement for human expertise.

What this means for you:
AI models show moderate accuracy in identifying intestinal infections in infants and can help support doctors' decisions.

Common questions

How accurate is the AI at finding this condition?

The AI models showed a sensitivity of 0.78 and a specificity of 0.84 when identifying necrotizing enterocolitis from X-rays. This means they have moderate accuracy. Because of differences in how studies were conducted, these tools are currently seen as helpful aids to support doctors rather than a standalone test.

What is necrotizing enterocolitis?

Necrotizing enterocolitis is a serious intestinal infection that can affect premature and very low birth weight infants. It requires quick diagnosis from abdominal radiographs (X-rays) to ensure the baby receives proper care.

Can doctors replace human judgment with AI?

No, these AI models are not intended to replace a doctor's expertise. Because of limited external validation and differences in study data, they are currently used as decision-support tools to help doctors make more informed choices during the diagnosis process.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
ContextNecrotising enterocolitis (NEC) is a leading cause of morbidity and mortality in premature and very low birth weight neonates. Early diagnosis is challenging as clinical and laboratory features are non-specific. Artificial intelligence (AI) offers a potential means to improve diagnostic consistency and timeliness.ObjectiveTo systematically review and meta-analyse the diagnostic accuracy of AI-based models for identifying NEC from abdominal radiographs.Evidence acquisitionA systematic search of MEDLINE, Embase, CINAHL, IEEE Xplore, and the Cochrane Library was conducted for studies published between January 1, 2015, and July 20, 2025. Studies evaluating AI, machine learning, or deep learning models applied to abdominal radiographs for NEC diagnosis or stratification, and reporting diagnostic performance metrics, were included. Study selection, data extraction, and risk-of-bias assessment (modified PROBAST) were performed independently by two reviewers. Diagnostic accuracy was pooled using hierarchical summary receiver operating characteristic models.ResultsTen retrospective studies met inclusion criteria; six were eligible for meta-analysis. Most employed convolutional neural networks, with limited external validation. The pooled sensitivity for AI-based diagnosis of NEC was 0.78 (95% CI 0.67–0.85) and pooled specificity was 0.84 (95% CI 0.73–0.91), with substantial heterogeneity. Positive and negative likelihood ratios were 4.84 and 0.27, respectively, indicating moderate diagnostic value. Explainability analyses commonly highlighted clinically relevant bowel features.ConclusionAI-based interpretation of abdominal radiographs demonstrates moderate accuracy for NEC diagnosis and may serve as a decision-support adjunct rather than a standalone test. Clinicians should view these tools as complementary aids within existing diagnostic frameworks, pending prospective validation of AI models and standardised implementation into existing workflows.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251090229.
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