ArticlePediatric radiology2026
The radiographic bubbly fecal pattern of intestinal pneumatosis in newborns revisited.
Article in Pediatric radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundA 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.
objectiveTo assess whether, and up to which age, a radiographic bubbly fecal pattern represents intestinal pneumatosis, using bowel ultrasound as the reference standard. MATERIALS AND
methodsInfants 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.
resultsA 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.
conclusionIn 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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