2026-07-06 | Prenatal corticosteroid use improves the severity and complications of necrotizing enterocolitis in preterm infants: a retrospective multicenter clinical study in China.

Our study is a retrospective multicenter observational cohort study to investigate effect of the use of antenatal corticosteroids (ACS) in preterm infants on the severity of necrotizing enterocolitis (NEC) and its associated complications. We collected clinical data from 443 preterm infants with gestational age (GA) of less than 37 weeks who were diagnosed with NEC in four hospitals across various provinces in China, covering the period from June 2020 to June 2024. According to whether they received a full course of prenatal corticosteroid treatment in the week before delivery, infants were divided into the exposed group and the unexposed group. A total of 213 preterm infants (48.08%) had received ACS therapy. When compared to the non-exposed group, the severity of NEC in the exposed group demonstrated a statistically significant difference (p = 0.005). Comparative analysis revealed that ethnicity, chorioamnionitis, antenatal steroid use, antenatal antibiotic use, premature rupture of membranes, gestational age, age at onset, respiratory support mode at onset, presence of intracranial hemorrhage before onset, postnatal occurrence of hemodynamically significant patent ductus arteriosus (hsPDA), absolute white blood cell count at onset, absolute platelet count at onset, and serum creatinine (SCr) levels during NEC (all p < 0.05) were identified as risk factors influencing NEC severity. In the univariate regression analysis, ACS therapy was identified as a significant protective factor against the occurrence of hsPDA (OR = 0.612, CI [0.385-0.974]), bronchopulmonary dysplasia (BPD) (OR = 0.611, CI [0.377-0.989]), and the need for surgical intervention (OR = 0.609, CI [0.384-0.967]). After adjusting for multiple confounding factors, ACS still demonstrated a protective effect against NEC severity (OR = 0.401, CI [0.257-0.672]), while chorioamnionitis (OR = 3.586, CI [1.571-8.185]), invasive respiratory support prior to onset (OR = 3.045, CI [1.464-6.330]), prenatal antibiotic use (OR = 3.752, CI [1.700-8.277]), and partially hydrolyzed formula feeding (OR = 3.500, CI [1.372-8.945]) were identified as significant risk factors for NEC severity. Therefore, ACS can reduce the severity of NEC and lower the incidence of hsPDA, BPD, and the necessity for surgical in preterm infants.

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2026-07-01 | The radiographic bubbly fecal pattern of intestinal pneumatosis in newborns revisited.

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

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