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How to use abdominal X-rays in preterm infants suspected of developing necrotising enterocolitis
  1. Roopali Soni1,
  2. Anastasia Katana1,
  3. Joe I Curry2,
  4. Paul D Humphries3,
  5. Angela Huertas-Ceballos1
  1. 1 Department of Neonatology, University College London Hospital, London, UK
  2. 2 Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK
  3. 3 Department of Radiology, Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Angela Huertas-Ceballos, Department of Neonatology, University College London Hospital, London WC1E 6DB, UK; a.huertas-ceballos{at}


Necrotising enterocolitis (NEC) in preterm babies is a serious gastrointestinal emergency with potentially devastating consequences. Prompt and accurate diagnosis continues to be a challenge for health professionals. Early identification of clinical warning signs is extremely important, but the diagnosis relies heavily on the interpretation of abdominal radiographs. Postgraduate training of paediatricians and neonatologists in neonatal abdominal radiography is scarce, and there is variability of radiological input to neonatal services. Lack of a standardised approach and descriptive terminology for interpretation may result in inadequate communication between clinical and surgical teams, inaccurate diagnosis, inappropriate treatment, and unnecessary cessation of feeds and transfers to surgical units. This paper offers a guide designed for the doctor who on a busy night shift needs to interpret an abdominal radiograph and decide on a differential diagnosis of NEC in a preterm baby. It helps to provide structure and standardisation to interpretation of radiological signs using a comprehensive but simple method to support the clinical diagnosis. Our aim is to enhance the correct diagnosis of NEC.

  • necrotising enterocolitis
  • prematurity
  • radiograph
  • perforation
  • pneumatosis
  • SIP
  • NEC
  • Abdominal X Ray
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  • Contributors SR corresponded with the editor of the Interpretations section of ADC Education & Practice and wrote the several drafts of the article based on the guidance provided. She performed a literature search, regularly contacted and met all the coauthors for comments, drafted the final version of the article, and collated the images for submission. AK performed a literature search to support the drafting of the article in its initial stages. She participated in reviewing the future drafts of the article. JIC and AH-C were instrumental in creating the ’proposed guide' within the article, on behalf of the GOSH surgical team and UCH Nutrition Group. They also both reviewed the many drafts of the article. JIC provided the X-ray images for the article. PDH works closely with the neonatal and surgical teams at ULCH and GOSH. His input was crucial in the final review of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Collaborators Jessica Bolton, Simon Blackburn, Christina Kortsalioudaki, Bashar Al Deiri, Katie MacKinnon, Simona Rusu, Ekene Enunwa, Louiza Kontara, Ava Tzankova.

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