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In recent years, the addition of bowel ultrasound (BUS) to the diagnostic evaluation of NEC has been shown to add value.

The combination of low sensitivity for the specific signs and low specificity for the sensitive signs often results in equivocal results by plain radiography alone.

2 Additional common but non-specific findings include air-fluid levels, bowel wall thickening and ascites. 10 The most sensitive finding of bowel wall dilation, present in greater than 90% of cases, is not specific to NEC. 2 9 Diagnosis of NEC can be made when pathognomonic signs such as portal venous gas (PVG) or pneumatosis intestinalis are present however, the sensitivity of these signs is relatively low especially in less severe cases of NEC. 8 It is well known, however, that AXR has significant limitations in diagnosing NEC. 6 7 Clinical examination and laboratory tests are not specific for the disease clinicians thus depend on abdominal radiographs (AXRs) to aid in the diagnosis of NEC. 2 4 5 Efforts to reduce the burden of NEC have been hindered in large part by the lack of advancements in NEC diagnosis. The mortality rate is higher after perforation thus, earlier detection of severely ischaemic or necrotic bowel loops, before perforation occurs, could improve the morbidity and mortality in NEC. 1, 2 3 While NEC is a disease that may progress rapidly, earlier diagnosis has the potential to improve outcomes through timely management including transfer to a surgical centre and surgical intervention as and when required.

Severe cases can ultimately lead to bowel perforation, widespread inflammatory response syndrome, multiorgan dysfunction and death. Necrotising enterocolitis (NEC) is characterised by overwhelming inflammation of the bowel wall causing intestinal injury and necrosis.