Bedside Ultrasound Outperforms Abdominal X-Ray in Neonatal Necrotizing Enterocolitis: Frontiers in Pediatrics | July 2026

Introduction:

Necrotizing enterocolitis (NEC) is one of the most serious gastrointestinal emergencies in neonates. Early identification of infants requiring surgical intervention is critical but remains challenging. This study compared bedside abdominal ultrasonography (US) with abdominal radiography (AXR) in predicting the need for surgery.

Why was this study needed?

Abdominal radiography has traditionally been the first-line imaging modality for NEC, but it has limited sensitivity in detecting bowel ischemia and perforation. Bedside ultrasound may provide additional information to improve surgical decision-making.

What did the study show?

• The study included 509 neonates with NEC, including 88 who required surgery.
• Bedside ultrasound predicted the need for surgery significantly better than abdominal radiography.
• Combining ultrasound with radiography further improved classification of patients at borderline risk.
• Complex peritoneal fluid was the strongest ultrasound predictor of surgical intervention.
• All imaging models demonstrated good calibration, supporting their clinical reliability.
• Ultrasound provided valuable real-time assessment of bowel viability and intra-abdominal complications beyond conventional X-ray findings.

Clinical Impact:

Bedside abdominal ultrasound should be incorporated into the routine assessment of neonates with NEC, particularly when the need for surgery is uncertain. Combining ultrasound with radiography can improve risk stratification and facilitate earlier surgical consultation.

Take-Home Message:

Bedside abdominal ultrasound is superior to abdominal radiography in identifying neonates with NEC who require surgery. Used alongside conventional X-rays, it enhances clinical decision-making and may enable more timely surgical intervention.