Title: Value of abdominal ultrasonography in predicting intestinal resection for premature
infants with necrotizing enterocolitis
Version: 2 Date: 12 Sep 2022
Reviewer's report:
The aim of this study was the assessment of abdominal ultrasound as diagnostic tool for Intestinal
resection in neonates with NEC. The study was performed in three centers. I think is very
important to highlight the role of abdominal ultrasound in NEC. I have some questions that
should be addressed:
1- What are the indications for surgery in these 3 centers? 68 out of 164 who underwent
laparotomy did not need a bowel resection. It feels like a high percentage as the author
commented as well. Why did they require surgery in the first place?
2- To performed diagnostic testing in a retrospective cohort is always risky, as the author
mentioned the risk of selection bias is high: for example the 83 + 26 patients that were not
included in the study ,were they different from the population studied in some way?
3- The indication for surgery can also induce a selection bias of course, maybe there are infants
who died before surgery because of bowel necrosis. It would be better to include all the infants
with verified NEC in the study.
4- In the method is stated: “The included AUS parameters and AR parameters exhibited
significant effects on predicting intestinal resection in the univariate analysis” . What do
“significant effects” mean exactly ? p value <0.05? I might be a sloppy reader but it is unclear
to me how the multivariate regression model is build.
5- There are no data regarding how sick the population studied was. Respiratory supports?
Inotropes?
6- In line 251 it is stated: “These findings should be signs of intestinal perforation, providing an
imaging reference for the selection of clinical treatment options, which was confirmed prior to
pneumoperitoneum, detected by abdominal X-ray examination.”  Which signs?  I suspect that
this line has been moved from another part of the discussion.
7. The references should be double checked. For example n 14 should be Fainglod´s study and
not Han SM, Knell J, Henry O, Riley H, Hong CR, Staffa SJ, Modi BP, Jaksic T. Long-term
outcomes of severe surgical necrotizing enterocolitis. J Pediatr Surg. 2020 May;55(5):848-851.
Title: Value of abdominal ultrasonography in predicting intestinal resection for premature
infants with necrotizing enterocolitis
Version: 2 Date: 12 Sep 2022
Reviewer's report:
The aim of this study was the assessment of abdominal ultrasound as diagnostic tool for Intestinal
resection in neonates with NEC. The study was performed in three centers. I think is very
important to highlight the role of abdominal ultrasound in NEC. I have some questions that
should be addressed:
1- What are the indications for surgery in these 3 centers? 68 out of 164 who underwent
laparotomy did not need a bowel resection. It feels like a high percentage as the author
commented as well. Why did they require surgery in the first place?
2- To performed diagnostic testing in a retrospective cohort is always risky, as the author
mentioned the risk of selection bias is high: for example the 83 + 26 patients that were not
included in the study ,were they different from the population studied in some way?
3- The indication for surgery can also induce a selection bias of course, maybe there are infants
who died before surgery because of bowel necrosis. It would be better to include all the infants
with verified NEC in the study.
4- In the method is stated: “The included AUS parameters and AR parameters exhibited
significant effects on predicting intestinal resection in the univariate analysis” . What do
“significant effects” mean exactly ? p value <0.05? I might be a sloppy reader but it is unclear
to me how the multivariate regression model is build.
5- There are no data regarding how sick the population studied was. Respiratory supports?
Inotropes?
6- In line 251 it is stated: “These findings should be signs of intestinal perforation, providing an
imaging reference for the selection of clinical treatment options, which was confirmed prior to
pneumoperitoneum, detected by abdominal X-ray examination.”  Which signs?  I suspect that
this line has been moved from another part of the discussion.
7. The references should be double checked. For example n 14 should be Fainglod´s study and
not Han SM, Knell J, Henry O, Riley H, Hong CR, Staffa SJ, Modi BP, Jaksic T. Long-term
outcomes of severe surgical necrotizing enterocolitis. J Pediatr Surg. 2020 May;55(5):848-851.
Please review this paper.
user
Title: Value of abdominal ultrasonography in predicting intestinal resection for premature
infants with necrotizing enterocolitis
Version: 2 Date: 12 Sep 2022
Reviewer's report:
The aim of this study was the assessment of abdominal ultrasound as diagnostic tool for Intestinal
resection in neonates with NEC. The study was performed in three centers. I think is very
important to highlight the role of abdominal ultrasound in NEC. I have some questions that
should be addressed:
1- What are the indications for surgery in these 3 centers? 68 out of 164 who underwent
laparotomy did not need a bowel resection. It feels like a high percentage as the author
commented as well. Why did they require surgery in the first place?
2- To performed diagnostic testing in a retrospective cohort is always risky, as the author
mentioned the risk of selection bias is high: for example the 83 + 26 patients that were not
included in the study ,were they different from the population studied in some way?
3- The indication for surgery can also induce a selection bias of course, maybe there are infants
who died before surgery because of bowel necrosis. It would be better to include all the infants
with verified NEC in the study.
4- In the method is stated: “The included AUS parameters and AR parameters exhibited
significant effects on predicting intestinal resection in the univariate analysis” . What do
“significant effects” mean exactly ? p value <0.05? I might be a sloppy reader but it is unclear
to me how the multivariate regression model is build.
5- There are no data regarding how sick the population studied was. Respiratory supports?
Inotropes?
6- In line 251 it is stated: “These findings should be signs of intestinal perforation, providing an
imaging reference for the selection of clinical treatment options, which was confirmed prior to
pneumoperitoneum, detected by abdominal X-ray examination.”  Which signs?  I suspect that
this line has been moved from another part of the discussion.
7. The references should be double checked. For example n 14 should be Fainglod´s study and
not Han SM, Knell J, Henry O, Riley H, Hong CR, Staffa SJ, Modi BP, Jaksic T. Long-term
outcomes of severe surgical necrotizing enterocolitis. J Pediatr Surg. 2020 May;55(5):848-851.
assistant