{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:44:02Z","timestamp":1789847042978,"version":"4.0.1"},"reference-count":52,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease and a major cause of morbidity and mortality among preterm infants. Traditional diagnostic methods such as abdominal radiography have limited sensitivity in early disease stages, prompting interest in bowel ultrasound (BUS) as a complementary imaging modality. Objective: This scoping review aims to synthesize existing literature on the role of ultra sound in the early detection, diagnosis, and management of NEC, with emphasis on its diagnostic performance, integration into clinical care, and technological innovations. Methods: Following PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Embase, Cochrane Library, and Google Scholar for studies published between January 2000 and December 2025. Inclusion criteria encompassed original research, reviews, and clinical studies evaluating the use of bowel, intestinal, or Doppler ultrasound in neonates with suspected or confirmed NEC. Data were extracted, categorized by study design, population characteristics, ultrasound features, and diagnostic outcomes, and qualitatively synthesized. Results: A total of 101 studies were included. BUS demonstrated superior sensitivity over radiography in detecting early features of NEC, including bowel wall thickening, portal venous gas, and altered peristalsis. Doppler ultrasound, both antenatal and postnatal, was effective in identifying perfusion deficits predictive of NEC onset. Neonatologist-performed ultrasound (NEOBUS) showed high interobserver agreement when standardized protocols were used. Emerging tools such as ultra-high-frequency ultrasound (UHFUS) and artificial intelligence (AI)-enhanced analysis hold potential to improve diagnostic precision. Point-of-care ultrasound (POCUS) appears feasible in resource-limited settings, though implementation barriers remain. Conclusions: Bowel ultrasound is a valuable adjunct to conventional imaging in NEC diagnosis. Standardized protocols, validation of advanced technologies, and out come-based studies are essential to guide its broader clinical adoption.<\/jats:p>","DOI":"10.3390\/diagnostics15151852","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T10:49:17Z","timestamp":1753267757000},"page":"1852","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Ultrasound for the Early Detection and Diagnosis of Necrotizing Enterocolitis: A Scoping Review of Emerging Evidence"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6815-8555","authenticated-orcid":false,"given":"Indrani","family":"Bhattacharjee","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Tufts University School of Medicine, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Todd","family":"Dolinger","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, NYU Grossman School of Medicine, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-1214","authenticated-orcid":false,"given":"Rachana","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Tufts University School of Medicine, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogen","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, UC Davis Children\u2019s Hospital, University of California, 2516 Stockton Blvd, TICON-II, Sacramento, CA 95817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/j.jpedsurg.2009.02.013","article-title":"Mortality of necrotizing enterocolitis expressed by birth weight categories","volume":"44","author":"Fitzgibbons","year":"2009","journal-title":"J. Pediatr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"F182","DOI":"10.1136\/archdischild-2017-313880","article-title":"Incidence of neonatal necrotizing enterocolitis in high-income countries: A systematic review","volume":"103","author":"Battersby","year":"2018","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Alsaied, A., Islam, N., and Thalib, L. (2020). Global incidence of necrotizing enterocolitis: A systematic review and meta-analysis. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-02231-5"},{"key":"ref_4","first-page":"562594","article-title":"Necrotizing enterocolitis in very low birth weight infants: A systemic review","volume":"2012","author":"Patel","year":"2012","journal-title":"Int. Sch. Res. Not."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1038\/s41390-021-01614-3","article-title":"Brain injury in preterm infants with surgical necrotizing enterocolitis: Clinical and bowel pathological correlates","volume":"91","author":"Garg","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_6","first-page":"CD012888","article-title":"Stopping enteral feeds for prevention of transfusion-associated necrotizing enterocolitis in preterm infants","volume":"2019","author":"Yeo","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s00281-020-00803-2","article-title":"Preterm birth and sustained inflammation: Consequences for the neonate","volume":"42","author":"Humberg","year":"2020","journal-title":"Semin. Immunopathol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Golubkova, A., and Hunter, C.J. (2023). Development of the neonatal intestinal barrier, microbiome, and susceptibility to NEC. Microorganisms, 11.","DOI":"10.3390\/microorganisms11051247"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/pm-23-29","article-title":"Necrotizing enterocolitis: An editorial","volume":"7","author":"Neu","year":"2024","journal-title":"Pediatr. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1038\/s41390-020-1074-4","article-title":"Defining necrotizing enterocolitis: Current difficulties and future opportunities","volume":"88","author":"Patel","year":"2020","journal-title":"Pediatr. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jpeds.2018.04.048","article-title":"Food Protein-Induced Enterocolitis Instead of Necrotizing Enterocolitis? A Neonatal Intensive Care Unit Case Series","volume":"200","author":"Lenfestey","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Cuna, A., Rathore, D., Bourret, K., Opfer, E., and Chan, S. (2024). Degree of Uncertainty in Reporting Imaging Findings for Necrotizing Enterocolitis: A Secondary Analysis from a Pilot Randomized Diagnostic Trial. Healthcare, 12.","DOI":"10.3390\/healthcare12050511"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"182","DOI":"10.5005\/jp-journals-11002-0002","article-title":"Imaging for diagnosis and assessment of necrotizing enterocolitis","volume":"1","author":"Mishra","year":"2022","journal-title":"Newborn"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kallis, M.P., Roberts, B., Aronowitz, D., Shi, Y., and Lipskar, A.M. (2023). Utilizing Ultrasound in Suspected Necrotizing Enterocolitis with Equivocal Radiographic Findings. BMC Pediatr., 23.","DOI":"10.1186\/s12887-023-03932-3"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3621","DOI":"10.1007\/s00330-018-5362-x","article-title":"The role of imaging in the management of necrotising enterocolitis: A multispecialist survey and a review of the literature","volume":"28","author":"Ahle","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1007\/s00247-022-05545-x","article-title":"Ultrasound for Necrotizing Enterocolitis: How Can We Optimize Imaging and What Are the Most Critical Findings?","volume":"53","author":"May","year":"2023","journal-title":"Pediatr. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1007\/s00247-005-1533-4","article-title":"Sonographic evaluation of neonates with early-stage necrotizing enterocolitis","volume":"35","author":"Kim","year":"2005","journal-title":"Pediatr. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Duci, M., Cosmi, E., Zorzato, P., Londero, A.P., Verlato, G., Baraldi, E., Ragazzi, E., Fascetti Leon, F., and Visentin, S. (2022). Fetal Doppler Evaluation to Predict NEC Development. J. Pers. Med., 12.","DOI":"10.3390\/jpm12071042"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/s41390-020-1090-4","article-title":"Challenges in diagnosing necrotizing enterocolitis","volume":"88","author":"Kim","year":"2020","journal-title":"Pediatr. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3283","DOI":"10.1002\/jum.15064","article-title":"Early Doppler ultrasound in the superior mesenteric artery and the prediction of necrotizing enterocolitis in preterm neonates","volume":"38","author":"Yue","year":"2019","journal-title":"J. Ultrasound Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1016\/j.amjsurg.2021.04.025","article-title":"Abdominal ultrasound findings contribute to a multivariable predictive risk score for surgical necrotizing enterocolitis: A pilot study","volume":"222","author":"Lazow","year":"2021","journal-title":"Am. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jpeds.2017.12.069","article-title":"Point-of-care fecal calprotectin monitoring in preterm infants at risk for necrotizing enterocolitis","volume":"196","author":"Nakayuenyongsuk","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s00247-023-05695-6","article-title":"A systematic review and meta-analysis of the role of Doppler ultrasonography of the superior mesenteric artery in detecting neonates at risk of necrotizing enterocolitis","volume":"53","author":"Rallis","year":"2023","journal-title":"Pediatr. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1007\/s00247-013-2725-y","article-title":"Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: Correlating findings with outcomes","volume":"43","author":"Muchantef","year":"2013","journal-title":"Pediatr. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Singh, D.K., Miller, C.M., Orgel, K.A., Dave, M., Mackay, S., and Good, M. (2023). Necrotizing enterocolitis: Bench to bedside approaches and advancing our understanding of disease pathogenesis. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.1107404"},{"key":"ref_26","first-page":"1317","article-title":"Value of Abdominal Ultrasound in Management of Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis","volume":"34","author":"Miyake","year":"2018","journal-title":"Pediatr. Surg. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"F445","DOI":"10.1136\/archdischild-2012-302848","article-title":"Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis","volume":"98","author":"Bohnhorst","year":"2013","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1007\/s00247-021-05187-5","article-title":"The role of ultrasound in necrotizing enterocolitis","volume":"52","author":"Hwang","year":"2022","journal-title":"Pediatr. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100048","DOI":"10.1016\/j.wfumbo.2024.100048","article-title":"Ultrasound role in diagnosis and as an assisting tool in prognostication of surgery in neonates with Necrotizing Enterocolitis","volume":"2","author":"Zarei","year":"2024","journal-title":"WFUMB Ultrasound Open"},{"key":"ref_30","first-page":"161","article-title":"Complex fluid collection on abdominal ultrasound indicates need for surgery in neonates with necrotizing enterocolitis","volume":"27","author":"Palleri","year":"2017","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e1816","DOI":"10.6061\/clinics\/2021\/e1816","article-title":"Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis","volume":"76","author":"Gao","year":"2021","journal-title":"Clinics"},{"key":"ref_32","first-page":"2304","article-title":"Ultra-high-frequency ultrasound (48\u201370 MHz) is a promising tool for improved gastrointestinal diagnostics in infants","volume":"113","author":"Jacobsen","year":"2024","journal-title":"Acta Paediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1177\/08465371241250197","article-title":"Applications of Artificial Intelligence in Acute Abdominal Imaging","volume":"75","author":"Yao","year":"2024","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Wu, Z., Zhuo, R., Liu, X., Wu, B., and Wang, J. (2024). Enhancing surgical decision-making in NEC with ResNet18: A deep learning approach to predict the need for surgery through X-ray image analysis. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1405780"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"107498","DOI":"10.1016\/j.ultras.2024.107498","article-title":"RfImagenet framework for segmentation of ultrasound images with spectra-augmented radiofrequency signals","volume":"146","author":"Xie","year":"2025","journal-title":"Ultrasonics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/1754-9485.13617","article-title":"Curds in the way: A milk curd obstruction review and normal sonographic bowel appearances using a novel scoring system in neonates on fortified breast milk feeds","volume":"68","author":"Kimble","year":"2024","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1136\/archdischild-2019-318382","article-title":"Implementation of Bowel Ultrasound Practice for the Diagnosis and Management of Necrotising Enterocolitis","volume":"106","author":"Chan","year":"2021","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/ajum.12114","article-title":"Neonatologist performed point-of-care bowel ultrasound: Is the time right?","volume":"22","author":"Priyadarshi","year":"2019","journal-title":"Australas. J. Ultrasound Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Moschino, L., Guiducci, S., Duci, M., Meggiolaro, L., Nardo, D., Bonadies, L., Salvadori, S., Verlato, G., and Baraldi, E. (2024). Noninvasive tools to predict necrotizing enterocolitis in infants with congenital heart diseases: A narrative review. Children, 11.","DOI":"10.3390\/children11111343"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Anuk Ince, D., Takci, S., Kilicdag, H., and Turan, O. (2024). Feeding difficulties in newborn infants and new approaches in practice. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1462493"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Xu, L., An, P., Zhou, J., Zhu, J., Liu, S., Zhou, Q., Li, X., and Xiong, Y. (2025). A nomogram for predicting adverse perinatal outcome with fetal growth restriction: A prospective observational study. BMC Pregnancy Childbirth, 25.","DOI":"10.1186\/s12884-025-07252-5"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Murphy, C., Baskind, S., Aladangady, N., and Banerjee, J. (2023). Measuring gut perfusion and blood flow in neonates using ultrasound Doppler of the superior mesenteric artery: A narrative review. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1154611"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1038\/s41390-022-02236-z","article-title":"Body composition and bone mass among 5-year-old survivors of necrotizing enterocolitis","volume":"93","author":"Magnusson","year":"2023","journal-title":"Pediatr. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e2022060053","DOI":"10.1542\/peds.2022-060053","article-title":"Use of point-of-care ultrasonography in the NICU for diagnostic and procedural purposes","volume":"150","author":"Stewart","year":"2022","journal-title":"Pediatrics"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Hawez, T., Graneli, C., Erl\u00f6v, T., Gottberg, E., Munoz Mitev, R., Hagelsteen, K., Evertsson, M., Jansson, T., Cinthio, M., and Stenstr\u00f6m, P. (2023). Ultra-High Frequency Ultrasound Imaging of Bowel Wall in Hirschsprung\u2019s Disease\u2014Correlation and Agreement Analyses of Histoanatomy. Diagnostics, 13.","DOI":"10.3390\/diagnostics13081388"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13054-020-2787-9","article-title":"International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)","volume":"24","author":"Singh","year":"2020","journal-title":"Crit. Care"},{"key":"ref_47","unstructured":"Li, Z., Li, L., Wei, J., Jiang, Q., and Wu, H. (2024). Construction of prediction model of neonatal necrotizing enterocolitis based on machine learning algorithms. Chin. J. Neonatol., 150\u2013156."},{"key":"ref_48","first-page":"2060","article-title":"Comparative study of ultrasound abdomen and X-ray abdomen in determining need for surgical intervention in neonates with necrotising enterocolitis","volume":"5","author":"Mathews","year":"2023","journal-title":"Int. J. Acad. Med. Pharm."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1136\/archdischild-2018-315252","article-title":"How to use abdominal X-rays in preterm infants suspected of developing necrotising enterocolitis","volume":"105","author":"Soni","year":"2020","journal-title":"Arch. Dis. Child. Educ. Pract. Ed."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"203","DOI":"10.5005\/jp-journals-11002-0070","article-title":"Point-of-care ultrasound to diagnose and monitor the course of necrotizing enterocolitis","volume":"2","author":"Chetan","year":"2023","journal-title":"Newborn"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s13312-023-2879-0","article-title":"Point-of-care ultrasound in neonatology in India: The way forward","volume":"60","author":"Rath","year":"2023","journal-title":"Indian Pediatr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/15\/1852\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:14:29Z","timestamp":1760033669000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/15\/1852"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,23]]},"references-count":52,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["diagnostics15151852"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15151852","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,23]]}}}