Integrating point-of-care ultrasound, objective bowel sound monitoring and probiotic preventative interventions in clinical care of preterm babies at risk of necrotising enterocolitis - A leap beyond conventional imaging and auscultation of the bowel

Abstract

Aim: To use a multi-modal approach to improve the diagnosis and monitoring of preterm gut, prone to injury in particular necrotising enterocolitis (NEC).

Methods: Evaluate precision in NEC diagnosis, objective bowel-sound monitoring, and examine probiotic strain efficacy in NEC prevention.

Results: Original diagnostic ultrasound findings in various neonatal bowel pathologies with their clinicopathological correlation described.

Combined ultrasound and X-ray provide improved risk stratification for the need for surgery in cases with suspected NEC. An Australasian-wide survey demonstrated a clear interest in point-of-care bowel ultrasound. Comparison of simultaneous auscultation and ultrasound for clinical assessment of bowel peristalsis in neonates showed a significant discrepancy between auscultated bowel sounds and real-time detection of bowel motility. Further machine learning models were developed to objectively detect bowel sounds (peristaltic sounds versus non-peristaltic sounds) with accuracy and area under the curve (AUC) of 89.81% and 83.96%, respectively.

Clinical outcomes of single vs. two-strain probiotic prophylaxis for prevention of NEC in preterm infants showed no differences in NEC rates, feeding outcomes, or all-cause morbidities, except for differences in the rates of retinopathy of prematurity.

Conclusions:

1. Improving diagnostic precision by integrating point-of-care ultrasound with abdominal X-ray provides a comprehensive assessment of the bowel adding clinical information on the bowel wall, bowel vascularity, and peristalsis, as well as evaluating for fluid collection within the intrabdominal compartment. 2. Our studies provide a groundwork for developing continuous bowel sound monitoring at the bedside for the early detection of bowel dysfunction. 3. Our probiotics study demonstrated that a single strain probiotic may be equally effective as a two-strain probiotic, further cluster-randomised controlled trials required.