Introduction: Necrotizing enterocolitis is the most common cause of the postnatal critical
conditions and remains one of the dominant causes of newborns’ death in Neonatal Intensive Care.
The morbidity and mortality associated with necrotizing enterocolitis remains largely unchanged
and the incidence of necrotizing enterocolitis continues to increase. There is no general agreement
regarding the surgical treatment of the necrotizing enterocolitis.
Methods: In this paper, we want to evaluate the results obtained in our centre from different types of
necrotizing enterocolitis’s surgical treatment and to analyse the role of traditional X-ray versus ultrasound
doppler imaging in the evolutionary phases of necrotizing enterocolitis. The study was
conducted in the Department of Emergency-Urgency NICU, A.O.R.N. Santobono-Pausilipon in
Naples from January 2010 to December 2016. Patients were monitored by hematochemical examinations
and radiological orthostatic exams every 12 hours, so that they had a surgical opportunity
before intestinal perforation occurred. Ultrasonography was performed to monitor preterm infants
who were hospitalized in NICU and that showed NEC symptomatology in phase I Bell staging.
Results: They were recruited 75 premature infants with NEC symptomatology in phase I-III of Bell
staging, who underwent surgical or medical treatment. In infants with a birth weight >1500 g
(N=30), laparotomy and necrotic bowel resection has generally been our preferred approach. In 46
patients we practiced a primary anastomosis after resection of an isolated necrotic intestinal segment.
In patients with multiple areas of necrosis and dubious intestinal vitality, were performed a
'second-look' scheduled after 24 to 48 hours to re-evaluate the intestine. In the initial phase of necrotizing
enterocolitis, when the radiographic examination shows only a specific dilation of the
loops, ultrasonography shows more and more specific signs, as wall thickening, alteration of parietal
echogenicity, increase in wall perfusion, single or sporadic airborne microbubbles in the thickness
of wall sections.
Conclusions: Optimal surgical therapy for NEC begins with adequate antibiotic therapy, reintegration
of liquids but above all with timely diagnosis, aimed to discover early prodromic phases of wall
damage by US, a fundamental tool. Abdomen radiography shows specificity frameworks only when
barrier damage is detected while US provides real-time imaging of abdominal structures, highlighting
some elements that are completely excluded by radiograph.