Introduction: Early diagnosis of necrotising enterocolitis (NEC) in preterm neonates remains challenging, with abdominal radiography (AXR) demonstrating limited sensitivity in early or evolving disease. Abdominal ultrasound (AUS) is increasingly recognised as a valuable adjunct for identifying early pathological changes; however, its clinical impact is limited by operator dependence, variability in scanning technique and inconsistent documentation. This presentation aims to review current literature relating to sonographic assessment of NEC and to propose a structured ultrasound technique to support earlier detection and management.
Method: The pathophysiology and clinical significance of NEC in the preterm neonate are reviewed to contextualise key sonographic findings. Current literature describing ultrasound technique and imaging appearances is examined. Key assessment elements include evaluation of bowel wall thickness, echogenicity, pneumatosis intestinalis, peristalsis and perfusion, in addition to assessment for portal venous gas and free fluid.
Results: Literature review identifies key sonographic features associated with early NEC and highlights the importance of a systematic assessment approach. Application of a structured ultrasound technique improves consistency of image acquisition and reporting, enabling earlier recognition of NEC features, particularly when AXR findings are equivocal. This supports increased diagnostic confidence and more timely clinical escalation.
Conclusion: Structured AUS reduces inter-operator variability and enhances the clinical utility of AUS in suspected NEC, supporting earlier detection and improved multidisciplinary communication.
Take home message: Ultrasound plays a key role in the early diagnosis and management of NEC. A systematic sonographic approach and recognition of key imaging features are essential to optimise diagnostic accuracy and patient outcomes.

Introduction: Our literature review suggests wide variation in accepted pyloric measurements for diagnosis and lack of agreement on which dimension of the pylorus is most accurate for diagnosis of HPS. A correct diagnosis is dependent on sonographer technique and measurement accuracy.
Methods: In a retrospective audit we analysed 161 cases of infants who underwent an ultrasound for suspected hypertrophic pyloric stenosis, with outcomes of evaluating accuracy of sonographic criteria for diagnosis of HPS through correlation with findings at time of surgery. A single observer retrospectively measured the length and transverse diameter of the pyloric canal, and thickness of the pyloric muscle. Measurements were double checked by a second observer and correlated with clinical and surgical findings.
Results: In infants with hypertrophic pyloric stenosis, mean pyloric muscle thickness was 4.7 mm +/- 0.8 mm, pyloric canal length was 19.6 +/-2.4 mm, and pyloric transverse diameter was 13.8 mm +/- 2.0 mm. In patients without hypertrophic pyloric stenosis, pyloric muscle thickness was 1.7 +/- 0.8 mm, pyloric canal length was 10.2 +/- 2.5 mm, and pyloric transverse diameter was 9.5 +/- 2.3 mm.
Conclusions: The mean pyloric measurements of this study are within the range of accepted diagnostic criteria of our institution. Ultrasound diagnosis is 100% congruent with post-surgical diagnosis of HPS. Study showed male predilection and increased likelihood of cases in younger age. No significant separation in measurement for positive and negative cases, and no significant difference in pyloric measurements based on patient age was found.