Ultrasound vs X-ray in Diagnosing Neonatal Intestinal Obstruction: A Systematic Review

Abstract

Background: Neonatal bowel obstruction is a life-threatening condition with the need for early and correct diagnosis to decrease morbidity and mortality. Conventionally, an abdominal Xray has been used as the initial imaging study, however newer studies are indicating that ultrasound may be more sensitive and useful in the clinical setting. Aim: The objective of this review was to compare ultrasound with abdominal X-ray for diagnosis of neonatal bowel obstruction in terms of diagnostic accuracy, early diagnosis, and impact on clinical outcomes over the last five years (2020–2024). Method: A systematic review of the literature was performed in five databases (PubMed, Scopus, ScienceDirect, Web of Science, CINAHL) according to PRISMA 2020 recommendations. Ten studies were included in the review. Directness was factored into the appraisal of quality and decision to analyze data. The primary search syntax focused on terms for neonatal obstruction and diagnostic imaging with ultrasound and X-ray. Results: The results indicated that US had a superior diagnostic accuracy between 91% and 96.6% (US) as compared with X-ray (72%), especially for its ability to diagnose specific causes (e.g., volvulus, malrotation, atresia). Ultrasound also enabled more rapid, real-time diagnosis, as was particularly important in neonatal intensive care environments. Although X-ray retained some validity in a few anatomical studies, the great majority of them confirmed that ultrasound was clinically superior. Conclusion: Ultrasonography is better than X-ray for dynamic diagnosis of neonatal intestinal obstruction. Incorporated into healthcare settings, it facilitates early diagnosis and the decision-making process. But use of the two modes together could represent a solution to more difficult diagnostic problems.