Handheld optical device detects necrotizing enterocolitis in premature infants before radiographic signs appear

For decades, neonatologists and pediatric surgeons have faced a grim diagnostic gap: necrotizing enterocolitis (NEC) often cannot be confirmed until it has progressed far enough to appear on abdominal radiographs, by which point surgical intervention may be unavoidable. A first-in-human study published in the Journal of Pediatric Surgery now reports that a handheld bedside device using broadband optical spectroscopy (BOS) may offer what the field has long lacked: a noninvasive, radiation-free method of detecting NEC in premature infants before irreversible intestinal injury takes hold.¹·⁵

"NEC is one of the most feared diagnoses in any neonatal intensive care unit, and the field has been searching for an early detection tool for decades," said senior author Seth Goldstein, MD, MPhil, pediatric general and thoracic surgeon at Ann & Robert H. Lurie Children's Hospital of Chicago and associate professor of surgery at Northwestern University Feinberg School of Medicine. "We are excited that our new handheld device reliably distinguishes NEC from healthy tissue within two minutes, and that it can be used at the bedside without subjecting these fragile babies to any pain or radiation."¹·⁵

Disease burden of NEC in the NICU and unmet need for early detection

NEC is the most common life-threatening gastrointestinal emergency in the neonatal intensive care unit. It occurs in approximately 2% to 5% of all premature infants, with incidence rising steeply as gestational age and birth weight decline — affecting up to 11% of very low birthweight (VLBW) infants under 1,500 g and as many as 22% of those under 1,000 g.²·³ Overall mortality ranges from 10% to 50%, with the highest fatality rates seen in those requiring surgery.⁴

The disease is characterized by an abrupt onset, rapid progression, and an early window during which antibiotic therapy alone may be sufficient. Once NEC advances beyond that window, bowel resection is frequently necessary, carrying risks of short bowel syndrome, intestinal failure, and neurodevelopmental impairment. Current diagnostic approaches, such as abdominal radiography, serum biomarkers, and clinical examination, are nonspecific and poorly sensitive for early-stage disease. Radiographic findings of pneumatosis intestinalis and portal venous gas indicate advanced disease rather than incipient injury.⁴

BOS study design and cohort

The Lurie Children's team, led by lead author and research fellow Ashley Dodd, MD, and developed in collaboration with biomedical engineer Vadim Backman's laboratory at Northwestern University, built on prior proof-of-concept work in a mouse NEC model before advancing to the human study.¹·⁵

Researchers enrolled 96 premature infants younger than 36 weeks gestational age who were admitted to the NICU and lacked congenital cardiac conditions or abdominal wall defects. The BOS device was placed gently on each infant's abdomen, emitting infrared light and detecting the spectral signature of the reflected signal from underlying intestinal tissue. The technology exploits the fact that ischemic bowel, long recognized by surgeons intraoperatively as having a characteristic discoloration, produces chromophores from cellular metabolic byproducts that alter tissue optical properties in a measurable way.¹·⁴·⁵

BOS accuracy and feasibility findings

Using a machine learning framework, iterative principal component analysis (iPCA) paired with neural network classification, the research group had previously demonstrated in NICU patients that BOS could distinguish NEC tissue with 88% accuracy, 89% sensitivity, and 88% specificity in an earlier signal-characterization study.⁵ The current first-in-human trial extended that work, confirming that BOS produced detectable and consistent signal differences between infants with NEC and healthy controls, that measurements were completed within two minutes, and that the procedure was well tolerated in this vulnerable population.¹

"Our results show that BOS is a safe and feasible technology that produced detectable signal changes in premature infants with NEC," Dr. Goldstein noted. "These findings suggest that BOS is a promising and potentially groundbreaking modality for screening and early detection of NEC."¹·⁵

Limitations and path forward

The study establishes biological plausibility and feasibility but stops short of the prospective, blinded screening trial design needed to validate BOS as a clinical screening tool. The cohort size of 96 infants, while meaningful for a first-in-human study, will require expansion across gestationally and demographically diverse NICU populations to assess generalizability. Performance metrics in the earliest Bell Stage I disease — the precise window where early detection holds the most value — have not yet been reported for the clinical cohort. Additionally, the extent to which BOS can reliably capture NEC signal in the presence of overlying edema, ascites, or abdominal wall pathology remains an open question.

The investigators have called for further studies to confirm whether BOS can function as a real-time screening instrument at the cribside, and whether serial measurements could track disease trajectory or response to antibiotic therapy. If subsequent trials bear out the findings, BOS would represent the first validated early-detection modality for NEC — addressing a diagnostic gap that has persisted for decades despite advances in neonatal intensive care.

References

1. Dodd AC, Goldstein SD, et al. First-in-human pilot study of broadband optical spectroscopy (BOS) as noninvasive surveillance for necrotizing enterocolitis (NEC). J Pediatr Surg. 2026. doi:10.1016/j.jpedsurg.2026.162978

2. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364(3):255–264. doi:10.1056/NEJMra1005408

3. Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates. JAMA. 2015;314(10):1039–1051. doi:10.1001/jama.2015.10244

4. Flowerday A, et al. Necrotizing enterocolitis detection in premature infants using broadband optical spectroscopy. J Biophotonics. 2025. doi:10.1002/jbio.202400273

5. Ann & Robert H. Lurie Children's Hospital of Chicago. New noninvasive tool may allow early detection of dangerous intestinal disease in preemies. EurekAlert! Published June 5, 2026. Accessed June 12, 2026. https://www.eurekalert.org/news-releases/1131105