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Erschienen in:

17.06.2022 | Short Communication

Feasibility and acceptability of a diagnostic randomized clinical trial of bowel ultrasound in infants with suspected necrotizing enterocolitis

verfasst von: Alain Cuna, Sherwin Chan, Jill Jones, Maura Sien, Amie Robinson, Karishma Rao, Erin Opfer

Erschienen in: European Journal of Pediatrics | Ausgabe 8/2022

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Abstract

We conducted a pilot diagnostic randomized clinical trial (RCT) to examine the feasibility, acceptability, and preliminary outcomes of adding bowel ultrasound (BUS) to the diagnostic evaluation for necrotizing enterocolitis (NEC). Infants ≤ 32 weeks’ gestational age with NEC concern were randomized to undergo abdominal X-ray (AXR) or AXR + BUS. The primary outcome was study feasibility. Secondary outcomes included rates of NEC diagnosis and duration of treatment with bowel rest and antibiotics. A total of 56 infants were enrolled; 16 developed NEC concern and were randomized. Rates of recruitment (56/82 = 68%), retention (16/16 = 100%), and protocol compliance (126/127 = 99%) met pre-specified thresholds for feasibility. No significant differences in rates of NEC diagnosis were found between the two groups. Durations of bowel rest and antibiotic treatment were also similar.
   Conclusion: Our study supports the feasibility of conducting a definitive diagnostic RCT to establish safety and efficacy of BUS for NEC.
   Clinical trial registration: The study was registered at https://​clinicaltrials.​gov (NCT03963011).
What is Known:
• Bowel ultrasound (BUS) is increasingly being utilized as an adjunct to abdominal radiographs in evaluating for necrotizing enterocolitis (NEC).
• The impact of BUS on patient outcomes is unknown.
What is New:
• A diagnostic randomized controlled trial study design to determine safety and effectiveness of adding BUS to NEC evaluation is feasible and acceptable.
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Literatur
1.
Zurück zum Zitat Zani A, Pierro A (2015) Necrotizing enterocolitis: controversies and challenges. F1000Res 4 Zani A, Pierro A (2015) Necrotizing enterocolitis: controversies and challenges. F1000Res 4
2.
Zurück zum Zitat Buonomo C (1999) The radiology of necrotizing enterocolitis. Radiol Clin North Am 37(1187–1198):vii Buonomo C (1999) The radiology of necrotizing enterocolitis. Radiol Clin North Am 37(1187–1198):vii
3.
Zurück zum Zitat Epelman M, Daneman A, Navarro OM, Morag I, Moore AM, Kim JH, Faingold R, Taylor G, Gerstle JT (2007) Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics 27:285–305CrossRef Epelman M, Daneman A, Navarro OM, Morag I, Moore AM, Kim JH, Faingold R, Taylor G, Gerstle JT (2007) Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics 27:285–305CrossRef
4.
Zurück zum Zitat Faingold R (2018) Technical aspects of abdominal ultrasound and color Doppler assessment of bowel viability in necrotizing enterocolitis. Pediatr Radiol 48:617–619CrossRef Faingold R (2018) Technical aspects of abdominal ultrasound and color Doppler assessment of bowel viability in necrotizing enterocolitis. Pediatr Radiol 48:617–619CrossRef
5.
Zurück zum Zitat Bohnhorst B (2013) Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 98:F445-450CrossRef Bohnhorst B (2013) Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 98:F445-450CrossRef
6.
Zurück zum Zitat Dordelmann M, Rau GA, Bartels D, Linke M, Derichs N, Behrens C, Bohnhorst B (2009) Evaluation of portal venous gas detected by ultrasound examination for diagnosis of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 94:F183-187CrossRef Dordelmann M, Rau GA, Bartels D, Linke M, Derichs N, Behrens C, Bohnhorst B (2009) Evaluation of portal venous gas detected by ultrasound examination for diagnosis of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 94:F183-187CrossRef
7.
Zurück zum Zitat Garbi-Goutel A, Brevaut-Malaty V, Panuel M, Michel F, Merrot T, Gire C (2014) Prognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age. J Pediatr Surg 49:508–513CrossRef Garbi-Goutel A, Brevaut-Malaty V, Panuel M, Michel F, Merrot T, Gire C (2014) Prognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age. J Pediatr Surg 49:508–513CrossRef
8.
Zurück zum Zitat Cuna AC, Reddy N, Robinson AL, Chan SS (2018) Bowel ultrasound for predicting surgical management of necrotizing enterocolitis: a systematic review and meta-analysis. Pediatr Radiol 48:658–666CrossRef Cuna AC, Reddy N, Robinson AL, Chan SS (2018) Bowel ultrasound for predicting surgical management of necrotizing enterocolitis: a systematic review and meta-analysis. Pediatr Radiol 48:658–666CrossRef
9.
Zurück zum Zitat Van den Bruel A, Cleemput I, Aertgeerts B, Ramaekers D, Buntinx F (2007) The evaluation of diagnostic tests: evidence on technical and diagnostic accuracy, impact on patient outcome and cost-effectiveness is needed. J Clin Epidemiol 60:1116–1122CrossRef Van den Bruel A, Cleemput I, Aertgeerts B, Ramaekers D, Buntinx F (2007) The evaluation of diagnostic tests: evidence on technical and diagnostic accuracy, impact on patient outcome and cost-effectiveness is needed. J Clin Epidemiol 60:1116–1122CrossRef
10.
Zurück zum Zitat Rodger M, Ramsay T, Fergusson D (2012) Diagnostic randomized controlled trials: the final frontier. Trials 13:137CrossRef Rodger M, Ramsay T, Fergusson D (2012) Diagnostic randomized controlled trials: the final frontier. Trials 13:137CrossRef
11.
Zurück zum Zitat Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA, group Pc (2016) CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ 355:i5239CrossRef Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA, group Pc (2016) CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ 355:i5239CrossRef
12.
Zurück zum Zitat Alexander KM, Chan SS, Opfer E, Cuna A, Fraser JD, Sharif S, Khashu M (2021) Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 106:96–103CrossRef Alexander KM, Chan SS, Opfer E, Cuna A, Fraser JD, Sharif S, Khashu M (2021) Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 106:96–103CrossRef
13.
Zurück zum Zitat Tracy SA, Lazow SP, Castro-Aragon IM, Fujii AM, Estroff JA, Parad RB, Staffa SJ, Zurakowski D, Chen C (2020) Is abdominal sonography a useful adjunct to abdominal radiography in evaluating neonates with suspected necrotizing enterocolitis? J Am Coll Surg 230(903–911):e902 Tracy SA, Lazow SP, Castro-Aragon IM, Fujii AM, Estroff JA, Parad RB, Staffa SJ, Zurakowski D, Chen C (2020) Is abdominal sonography a useful adjunct to abdominal radiography in evaluating neonates with suspected necrotizing enterocolitis? J Am Coll Surg 230(903–911):e902
14.
Zurück zum Zitat Vernacchia FS, Jeffrey RB, Laing FC, Wing VW (1985) Sonographic recognition of pneumatosis intestinalis. AJR Am J Roentgenol 145:51–52CrossRef Vernacchia FS, Jeffrey RB, Laing FC, Wing VW (1985) Sonographic recognition of pneumatosis intestinalis. AJR Am J Roentgenol 145:51–52CrossRef
15.
Zurück zum Zitat Elsayed Y, Seshia M (2022) A new intestinal ultrasound integrated approach for the management of neonatal gut injury. Eur J Pediatr 181:1739–1749CrossRef Elsayed Y, Seshia M (2022) A new intestinal ultrasound integrated approach for the management of neonatal gut injury. Eur J Pediatr 181:1739–1749CrossRef
Metadaten
Titel
Feasibility and acceptability of a diagnostic randomized clinical trial of bowel ultrasound in infants with suspected necrotizing enterocolitis
verfasst von
Alain Cuna
Sherwin Chan
Jill Jones
Maura Sien
Amie Robinson
Karishma Rao
Erin Opfer
Publikationsdatum
17.06.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Pediatrics / Ausgabe 8/2022
Print ISSN: 0340-6199
Elektronische ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-022-04526-4

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