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Published on: December 1, 2012
Outcome in VLBW infants with surgical intestinal disorder at 18 months of corrected age
Masahiro Hayakawa1, Tomoaki Taguchi2, Naoto Urushihara3
1Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
Insights
Necrotizing enterocolitis (NEC) and meconium-related ileus (MRI) increase mortality in very low-birthweight infants (VLBWI). MRI also elevates the risk of neurodevelopmental impairment (NDI) or death by 18 months corrected age.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Neonatal intensive care
Background:
- Surgical intestinal disorders like NEC, FIP, and MRI are significant causes of morbidity in VLBWI.
- Early identification and management of these conditions are crucial for improving infant outcomes.
Purpose of the Study:
- To compare composite outcomes of death or NDI in VLBWI with surgical intestinal disorders.
- To identify independent risk factors for death and NDI at 18 months corrected age.
Main Methods:
- A retrospective matched-cohort study involving 11 institutes.
- Included VLBWI who underwent laparotomy for NEC, FIP, or MRI.
- Matched control subjects (2:1 ratio) based on gestational age and birthweight.
Main Results:
- In-hospital mortality was higher in NEC and MRI groups compared to controls.
- NDI incidence at 18 months corrected age was higher in the MRI group versus controls.
- Low gestational age, male sex, SGA, IVH, and MRI were independent risk factors for death or NDI.
Conclusions:
- NEC and MRI are linked to increased in-hospital mortality in VLBWI.
- MRI is associated with a higher risk of NDI or death at 18 months corrected age.
Background:
Surgical intestinal disorders, such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in very low-birthweight infants (VLBWI). The aim of this study was to compare the composite outcomes of death or neurodevelopmental impairment (NDI) in VLBWI with surgical intestinal disorders and assess independent risk factors for death and NDI at 18 months of corrected age.
Methods:
A retrospective matched-cohort study was conducted at 11 institutes. We included VLBWI who had undergone laparotomy for NEC, FIP, and MRI. Two control subjects were chosen for every surgical patient and matched for gestational age and birthweight to form the comparison group. Death and neurodevelopmental outcome at 18 months of corrected age were evaluated.
Results:
The number of infants in the NEC, FIP, MRI, and control groups was 44, 47, 42, and 261, respectively. In-hospital mortality was higher in infants with NEC and MRI relative to those in the control group (P < 0.001). The incidence rate for NDI at 18 months of corrected age was higher in infants with MRI relative to those in the control group (P = 0.021). On logistic regression analysis, low gestational age, male sex, small for gestational age, intraventricular hemorrhage, and MRI were associated with increased risk of death or NDI at 18 months of corrected age.
Conclusions:
NEC and MRI were associated with in-hospital mortality, and MRI was associated with NDI or death at 18 months of corrected age.
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