Clinical implications of abdominal ultrasound in early onset neonatal sepsis

ABSTRACT

Abdominal sonography may be of great value in the evaluation and early detection of sequel of neonatal sepsis. A significant number of neonates develop clinical signs compatible with necrotizing enterocolitis, cholecystitis but with inconclusive plain radiographs, which may result in delayed, inappropriate or unnecessary therapy. Therefore, this prospective study is an attempt to assess the abdominal ultrasonographic abnormalities in neonatal sepsis, correlate it with the clinical findings and evaluate its impact on the early diagnosis of sequel of neonatal sepsis. This study was conducted on 56 consecutive neonates [36 males and 20 females] with sepsis admitted to the NICU of the Obstetrics and Gynecology Department, Ain Shams University Hospitals. Their mean gestational age was 34.0 +/- 4.5 weeks; their mean birth weight was 2.2 +/- 0.530kg. All patients were subjected to history taking, clinical evaluation, laboratory investigations and radiological evaluation, including plain chest and abdominal x-rays as well as abdominal ultrasonographic examination. The study showed that 59% of patients had hepatomegaly, 25% had splenomegaly, and 7% had ascites. Specific findings of necrotizing enterocolitis [NEC] were detected in 14 patients [25%], while gall bladder abnormalities per se were detected in 57% of septic patients. Mixed abdominal ultrasonographic findings were recorded in 20 cases [35.71%]. Specific findings of NEC included pneumatosis intestinalis [17.9%], thickened intestinal wall [25%] and air in portal vein [7.14%]. As regards gall bladder affection the following sonographic abnormalities were detected thickened gall bladder wall [28.5%], biliary sludge / mud [17.9%], pneumobilia [7.14%] and hydrops [3.57%]. Risk factors for developing NEC included sepsis, prematurity, total parentral nutrition [TPN], umbilical vein catheterization and birth asphyxia. The most frequent risk factors for gall bladder affection were sepsis, nothing per [NPO], TPN, blood or blood products transfusion as well as mechanical ventilation. In conclusion, NEC, gall bladder affection and hepatosplenomegaly are complications of neonatal sepsis in NICU and could be detected early by ultrasound examination prior to plain radiography. Abdominal ultrasound is a simple, quick, easy and cost effective method, therefore it is recommended to be used for the evaluation and follow up of septic infants in NICU