The radiographic bubbly fecal pattern of intestinal pneumatosis in newborns revisited.

BACKGROUND

A bubbly fecal pattern on abdominal radiographs of neonates was described in the 1980s as a potential sign of intestinal pneumatosis, particularly in preterm infants during the first 2 weeks of life. This sign has not been systematically re-evaluated or correlated with sonographic findings.

OBJECTIVE

To assess whether, and up to which age, a radiographic bubbly fecal pattern represents intestinal pneumatosis, using bowel ultrasound as the reference standard.

MATERIALS AND

METHODS

Infants aged 0-97 days who underwent abdominal radiography and bowel ultrasound for suspected ischemic enterocolitis in the neonatal intensive care unit were retrospectively included between January 2012 and December 2023. Radiography and ultrasound had to be performed within 24 h of each other. Imaging findings were analyzed per patient and per imaging episode.

RESULTS

A total of 191 infants (82 female) were included, resulting in 402 paired examinations. Median age at imaging was 18 days. A bubbly fecal pattern was identified on 212 radiographs in 119 infants, with sonographic intestinal pneumatosis present in 172 cases (81.1%). Positive predictive values were consistently high, reaching 80.7% overall, while specificity and negative predictive values remained low across all age groups. A negative ultrasound in the presence of a bubbly fecal pattern was associated with a low surgical rate (6.5%). Sonographic pneumatosis was present in 90% of infants who underwent surgery.

CONCLUSION

In infants evaluated for suspected necrotizing/ischemic enterocolitis, a radiographic bubbly fecal pattern is a relevant imaging sign associated with intestinal pneumatosis, particularly during the first 8 weeks of life.