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Outcomes at 7 years for babies who developed neonatal necrotising enterocolitis: the ORACLE Children Study
Katie Pike1, Peter Brocklehurst, David Jones
1Bristol Heart Institute, University of Bristol, Bristol, UK.
Insights
Neonatal necrotising enterocolitis (NEC) can lead to long-term functional impairments and bowel problems in children up to age 7. This study highlights the persistent health challenges faced by children with a history of NEC.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Longitudinal Cohort Studies
Background:
- Evaluating long-term outcomes of neonatal necrotising enterocolitis (NEC) in children at age 7.
- Utilizing the ORACLE Children Study Cohort for comprehensive assessment.
Purpose of the Study:
- To determine the lasting consequences of neonatal NEC on children's health and development.
- To assess functional, medical, behavioral, and educational outcomes at school age.
Main Methods:
- Parental questionnaires including the Health Utilities Index (HUI-3) for functional impairment.
- Analysis of national standardized tests for educational outcomes in England.
- Logistic regression to identify independent associates of NEC.
Main Results:
- NEC increased the risk of neonatal death (OR 14.6).
- At age 7, NEC was associated with increased risk of functional impairment (aOR 1.55), particularly mild impairment (aOR 1.61).
- Children with NEC had higher odds of bowel problems (aOR 3.96) but no confirmed behavioral or educational deficits.
Conclusions:
- Neonatal NEC has significant long-term impacts on gut function and functional outcomes (motor, sensory, cognitive) at school age.
- The ORACLE Children Study provides the largest evaluation of school-age outcomes following neonatal NEC.
Background:
Within the ORACLE Children Study Cohort, the authors have evaluated long-term consequences of the diagnosis of confirmed or suspected neonatal necrotising enterocolitis (NEC) at age of 7 years.
Methods:
Outcomes were assessed using a parental questionnaire, including the Health Utilities Index (HUI-3) to assess functional impairment, and specific medical and behavioural outcomes. Educational outcomes for children in England were explored using national standardised tests. Multiple logistic regression was used to explore independent associates of NEC within the cohort.
Results:
The authors obtained data for 119 (77%) of 157 children following proven or suspected NEC and compared their outcomes with those of the remaining 6496 children. NEC was associated with an increase in risk of neonatal death (OR 14.6 (95% CI 10.4 to 20.6)). At 7 years, NEC conferred an increased risk of all grades of impairment. Adjusting for confounders, risks persisted for any HUI-3 defined functional impairment (adjusted OR 1.55 (1.05, 2.29)), particularly mild impairment (adjusted OR 1.61 (1.03, 2.53)) both in all NEC children and in those with proven NEC, which appeared to be independent. No behavioural or educational associations were confirmed. Following NEC, children were more likely to suffer bowel problems than non-NEC children (adjusted OR 3.96 (2.06, 7.61)).
Conclusions:
The ORACLE Children Study provided opportunity for the largest evaluation of school age outcome following neonatal NEC and demonstrates significant long-term consequences of both gut function (presence of stoma, admission for bowel problems and continuing medical care for gut-related problems) and motor, sensory and cognitive outcomes as measured using HUI-3.
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