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Neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical
R Wadhawan1, W Oh1, S R Hintz2
1Department of Pediatrics, Women & Infants Hospital, Providence, RI, USA.
Insights
Extremely low birth weight infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation face higher risks of death or neurodevelopmental impairment. These risks persist even among survivors at 18-22 months corrected age.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Developmental Pediatrics
Background:
- Extremely low birth weight (ELBW) infants are vulnerable to serious gastrointestinal complications.
- Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are significant causes of morbidity and mortality in ELBW infants.
Purpose of the Study:
- To compare the risks of death and neurodevelopmental impairment (NDI) in ELBW infants with surgical NEC versus SIP and infants with neither condition.
- To assess NDI among survivors at 18-22 months corrected age.
Main Methods:
- Retrospective analysis of the Neonatal Research Network very low birth weight registry (2000-2005).
- Infants categorized into three groups: SIP, surgical NEC (Bell's stage III), or neither.
- Multivariate logistic regression controlled for confounding factors to assess outcomes.
Main Results:
- Surgical NEC group had the highest mortality (53.5%) and death/NDI rates (82.3%).
- SIP group showed elevated death/NDI rates (79.3%) compared to controls (53.3%).
- Both SIP and surgical NEC were independently associated with increased risk of death/NDI and NDI in survivors.
Conclusions:
- Both spontaneous intestinal perforation and surgical necrotizing enterocolitis significantly increase the risk of death or neurodevelopmental impairment in ELBW infants.
- These risks are comparable between SIP and surgical NEC and extend to neurodevelopmental outcomes in survivors.
Objective:
To determine if extremely low birth weight infants with surgical necrotizing enterocolitis have a higher risk of death or neurodevelopmental impairment and neurodevelopmental impairment among survivors (secondary outcome) at 18-22 months corrected age compared with infants with spontaneous intestinal perforation and infants without necrotizing enterocolitis or spontaneous intestinal perforation.
Study Design:
Retrospective analysis of the Neonatal Research Network very low birth weight registry, evaluating extremely low birth weight infants born between 2000 and 2005. The study infants were designated into three groups: (1) spontaneous intestinal perforation without necrotizing enterocolitis; (2) surgical necrotizing enterocolitis (Bell's stage III); and (3) neither spontaneous intestinal perforation nor necrotizing enterocolitis. Multivariate logistic regression analysis was performed to evaluate the association between the clinical group and death or neurodevelopmental impairment, controlling for multiple confounding factors including center.
Result:
Infants with surgical necrotizing enterocolitis had the highest rate of death before hospital discharge (53.5%) and death or neurodevelopmental impairment (82.3%) compared with infants in the spontaneous intestinal perforation group (39.1 and 79.3%) and no necrotizing enterocolitis/no spontaneous intestinal perforation group (22.1 and 53.3%; P<0.001). Similar results were observed for neurodevelopmental impairment among survivors. On logistic regression analysis, both spontaneous intestinal perforation and surgical necrotizing enterocolitis were associated with increased risk of death or neurodevelopmental impairment (adjusted odds ratio 2.21, 95% confidence interval (CI): 1.5, 3.2 and adjusted OR 2.11, 95% CI: 1.5, 2.9, respectively) and neurodevelopmental impairment among survivors (adjusted OR 2.17, 95% CI: 1.4, 3.2 and adjusted OR 1.70, 95% CI: 1.2, 2.4, respectively).
Conclusion:
Spontaneous intestinal perforation and surgical necrotizing enterocolitis are associated with a similar increase in the risk of death or neurodevelopmental impairment and neurodevelopmental impairment among extremely low birth weight survivors at 18-22 months corrected age.
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