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Abdominal ultrasound detects portal venous gas more frequently than conventional radiography in neonatal necrotizing enterocolitisUltrasound may help detect early signs of infant intestinal disease

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Key Takeaway
Consider combining abdominal ultrasound and radiography to improve detection of progression in neonatal necrotizing enterocolitis.

This meta-analysis evaluated the diagnostic performance of abdominal ultrasound (AUS) compared to conventional radiography (AXR) in identifying features of necrotizing enterocolitis among 1,793 neonates. The study focused on several key radiological indicators including portal venous gas, pneumatosis intestinalis, pneumoperitoneum, and intestinal dilatation.

The primary finding was that AUS detected portal venous gas significantly more frequently than AXR (OR: 2.32; 95% CI [1.35-3.99]). Other features showed less definitive differences: pneumatosis intestinalis was detected more frequently with AUS but was not statistically significant (OR: 1.21; 95% CI [0.82-1.80]). AXR detected pneumoperitoneum and intestinal dilatation more frequently than AUS, though neither finding reached statistical significance (OR: 0.62; 95% CI [0.31-1.26] and OR: 0.51; 95% CI [0.19-1.40], respectively).

Clinical implications suggest that combining AUS and AXR may facilitate earlier recognition and assessment of disease progression in neonatal cases. However, the study does not establish a causal link between ultrasound use and improved clinical outcomes, only differences in detection frequencies of specific radiological signs.

How this fits prior evidence

This meta-analysis addresses gaps in imaging modalities for necrotizing enterocolitis. It complements existing evidence regarding risk factors such as early postnatal antibiotic exposure and the impact of various nutritional formulas on NEC rates. While AI models have shown moderate sensitivity for diagnosis, this study specifically quantifies the comparative detection frequencies between ultrasound and radiography for specific markers like portal venous gas.

When a newborn develops necrotizing enterocolitis, doctors must act fast to identify signs of intestinal damage. This condition is serious and requires quick diagnosis. A review of data from 1,793 infants looked at how well two different imaging tools work: abdominal ultrasound (AUS) and conventional radiography (AXR), which is a standard X-ray.

The analysis found that ultrasounds were much more likely to detect portal venous gas, a specific sign of the disease. While other signs like intestinal dilation or air in the bowel walls were detected by both methods at similar rates, the ultrasound showed a clear advantage for one specific marker.

It is important to note that these results only show how often certain signs are spotted on an image. The study does not prove that using an ultrasound leads to better health outcomes for babies. Instead, it suggests that using both types of imaging together might help doctors spot the disease and track its progress more effectively.

What this means for you:
Ultrasounds can detect specific signs of necrotizing enterocolitis in newborns more frequently than X-rays.

Common questions

How does ultrasound compare to X-rays for detecting intestinal issues?

In a study of 1,793 neonates, ultrasounds were found to detect portal venous gas more frequently than standard X-rays. While both methods detected other signs like intestinal dilation and pneumatosis intestinalis, the ultrasound showed a specific advantage in identifying portal venous gas.

What is necrotizing enterocolitis?

Necrotizing enterocolitis is a serious condition affecting the intestines of newborns. Doctors use imaging like ultrasounds and X-rays to look for specific signs, such as portal venous gas or intestinal dilation, to identify the disease and monitor how it progresses.

Does using an ultrasound mean better outcomes for babies?

The study shows that ultrasounds can detect certain markers of the disease more often than X-rays. However, this does not prove that using an ultrasound leads to better clinical results; it only shows differences in how often specific signs appear on the scans.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
ObjectiveTo synthesize the existing evidence regarding the differences between abdominal ultrasound (AUS) and conventional radiography in detecting necrotizing enterocolitis (NEC) features in neonates.MethodsA six-database literature search was conducted to identify relevant English-language studies published prior to April 1, 2026 comparing the detection frequencies of AUS and abdominal x-ray (AXR) for imaging signs of neonatal NEC.ResultsTwenty studies were identified that systematically compared the detection frequencies of AUS vs. AXR for detecting specific NEC features (n = 1,793 neonates with confirmed or suspected NEC). AUS detected portal venous gas more frequently than AXR [odds ratio (OR): 2.32; 95% confidence interval (CI) [1.35–3.99]] and exhibits a higher, albeit not significant, detection frequency for pneumatosis intestinalis [OR: 1.21; 95% CI (0.82–1.80)]. AXR detected pneumoperitoneum [OR: 0.62; 95% CI (0.31–1.26)] and intestinal dilatation [OR: 0.51; 95% CI (0.19–1.40)] more frequently than AUS, though neither frequency was statistically significant.ConclusionsAUS and AXR show different patterns of detection of abnormal signs in NEC, with the former detecting portal gas and pneumatosis intestinalis more frequently than the latter. Combining the two modalities in clinical practice may facilitate earlier recognition and assessment of disease progression in neonatal NEC cases.
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