Neonatal Nurse Practitioner Practice Exam

In neonates with suspected necrotizing enterocolitis, what x-ray finding is critical to diagnose bowel perforation?

1. Free air under the diaphragm

2. Pneumoperitoneum

3. Thickened bowel wall

4. Absence of bowel gas

The correct answer is: Pneumoperitoneum

The presence of pneumoperitoneum is critical for diagnosing bowel perforation in neonates with suspected necrotizing enterocolitis. Pneumoperitoneum refers to the presence of air within the peritoneal cavity, which typically occurs when there is a perforation in the bowel allowing intestinal gas to leak into the abdominal cavity. This finding is considered a surgical emergency, as it indicates that the integrity of the bowel has been compromised and there is a risk of peritonitis, an infection of the peritoneal cavity. The identification of pneumoperitoneum on an x-ray is usually visualized as a crescent of air under the diaphragm, but it can also appear free in other parts of the abdominal cavity. Recognizing this finding is critical for prompt intervention, often involving surgery to repair the perforation and prevent further complications. Other x-ray findings in cases of suspected intestinal issues, such as thickened bowel walls or absence of bowel gas, may support a diagnosis of necrotizing enterocolitis but do not specifically indicate perforation. Additionally, free air under the diaphragm can be a sign of perforation but is less definitive in neonates compared to the presence of pneumoperitoneum itself, which strongly suggests the need for surgical