Availability, utilization, and barriers to bowel ultrasound for necrotizing enterocolitis: a national multidisciplinary survey.

OBJECTIVE

To characterize availability, utilization, and barriers to bowel ultrasound (BUS) for necrotizing enterocolitis (NEC).

METHODS

A survey of neonatologists, surgeons, and radiologists at Children's Hospitals' Neonatal Consortium (CHNC) sites. Quantitative data were analyzed descriptively; open-ended responses underwent thematic analysis.

RESULTS

In total, 104 respondents from 42/46 institutions participated. BUS was available at 83% of level IV NICU sites, with 64% reporting 24/7 availability. However, only 42% of affiliated level III NICUs had BUS available. BUS was primarily used alongside radiographs in cases of diagnostic uncertainty and variably used to guide surgical decisions. Radiologists frequently used protocols while neonatologists and surgeons reported limited training and few institutional guidelines. Key barriers included lack of standardization, inadequate training, and unclear clinical utility.

CONCLUSION

BUS is increasingly available in level IV NICUs but less so in level III NICUs. Even when available, clinical integration is inconsistent due to gaps in standardization, training, and supporting evidence.