A BUBBLY faecal pattern on abdominal radiographs may be a relevant imaging sign of intestinal pneumatosis in infants being assessed for suspected necrotising or ischaemic enterocolitis, particularly during the first eight weeks of life, according to a retrospective imaging study.
Necrotising or ischaemic enterocolitis is a serious and potentially life-threatening bowel disease in which the intestinal lining becomes inflamed and damaged. Severe cases can progress to bowel necrosis and require surgery.
Researchers re-examined a radiographic sign first described in the 1980s, evaluating whether the bubbly faecal pattern reflects intestinal pneumatosis when compared with bowel ultrasound, which served as the reference standard. The findings suggest the radiographic feature retains clinical relevance and could support imaging assessment in neonatal intensive care settings.
Bubbly Faecal Pattern Shows High Predictive Value
The study included infants aged 0–97 days who underwent both abdominal radiography and bowel ultrasound for suspected necrotising or ischaemic enterocolitis in a neonatal intensive care unit between January 2012 and December 2023. To be eligible, both imaging examinations had to be performed within 24 hours of each other.
A total of 191 infants, including 82 females, contributed 402 paired imaging examinations. The median age at imaging was 18 days.
Investigators identified a bubbly faecal pattern on 212 radiographs from 119 infants. Ultrasound confirmed intestinal pneumatosis in 172 of these cases, meaning the radiographic finding correctly predicted sonographic pneumatosis in 81.1% of instances. Overall, the positive predictive value reached 80.7%.
Ultrasound Findings May Help Guide Clinical Decisions
Although the bubbly faecal pattern demonstrated consistently high positive predictive values across age groups, specificity and negative predictive values remained low throughout the analysis. This indicates that while the sign may help identify intestinal pneumatosis when present, its absence does not reliably exclude the condition.
Among infants with a bubbly faecal pattern but a negative bowel ultrasound, the surgical rate was low at 6.5%. By contrast, sonographic intestinal pneumatosis was identified in 90% of infants who ultimately underwent surgery.
Findings Support Imaging Assessment in Early Life
The findings suggest the radiographic sign remains relevant when assessing infants for suspected necrotising or ischaemic enterocolitis in neonatal intensive care However, the retrospective design and inclusion of infants already undergoing imaging for suspected disease mean the findings should be interpreted within that clinical context.
Reference
Schmidt MS et al. The radiographic bubbly fecal pattern of intestinal pneumatosis in newborns revisited. Pediatr Radiol. 2026;DOI:10.1007/s00247-026-06703-1.
Featured image: Sergey Novikov on Adobe Stock
- Author:
