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Pediatric Imaging

E2712. Plain Abdominal Radiographic Imaging of Premature Neonates

Gunasekaran V1,  Joshi A1,  Gunduru M1,  Jayapal P.2 1. Wayne State University, Detroit, MI; 2. Hartford Hospital, Hartford, CT

Address correspondence to V. Gunasekaran (

Background Information: Abdominal radiographs are usually performed to check for the placement of lines/tubes, abdominal distension with possible concerns for NEC and pneumoperitoneum in premature babies. Incidence of prematurity (more than 1 in 10 live births) is slightly increased in 2014–2015 according to CDC and 90% of NEC occurs in preterm infants. Intestinal perforation in a premature infant with NEC is a very common situation that requires emergency surgical management.

Educational Goals/Teaching Points: We review of the basic abdomen radiograph reading and provide an overview of the characteristic radiographic signs associated with various clinicopathological conditions. Pathophysiology, clinical presentation, and risk factors for NEC will be considered. We present signs of pneumoperitoneum and anatomic landmarks for UAC/UVC and nasogastric tube. We discuss use of ultrasound in NEC.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Radiography is the most important step to start with where we can find the positioning of the supportive lines/tubes, bowel gas pattern, free air, air fluid level or any other radio opaque FB/calcification. Necrotizing enterocolitis presents with pneumatosis intestinalis, portal venous gas and bowel wall thickening. Pneumoperitoneum has free air under the right diaphragm. Football and Rigler sign are seen as well. Malpositioning of the UAC/UVC is well seen in abdominal imaging that can lead to several complications like hemorrhage and cardiac arrhythmia.

Conclusion: Simple bedside plain radiography is easy to do, less time-consuming and low-dose radiation exposure. It is the best initial step that guides us to further imaging or management. Radiological signs may precede the clinical signs in NEC. Early diagnosis of NEC and pneumoperitoneum significantly decreases the mortality rate. Serial abdominal radiography is essential for further follow-up in NEC. There has been increasing use of ultrasound nowadays, as the possibility of detecting early stages of disease is higher.