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Updated: Nov 22, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Discrepancy between the survival rate and neuropsychological development in postsurgical extremely low-birth-weight
Mitsuru Muto1, Koshiro Sugita2, Satoshi Ibara3
1Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan. mitsuru@m3.kufm.kagoshima-u.ac.jp.
Insights
Survival rates for extremely low-birth-weight infants with necrotizing enterocolitis and focal intestinal perforation improved, but neuropsychological development remained poor. Further research is needed to enhance outcomes for these vulnerable infants.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Infant neurodevelopment
Background:
- Necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI) are critical gastrointestinal diseases in extremely low-birth-weight infants (ELBWIs).
- Postoperative outcomes for these conditions in ELBWIs require ongoing evaluation to improve patient care.
- Understanding trends in surgical outcomes and neurodevelopment is crucial for advancing neonatal intensive care.
Purpose of the Study:
- To compare postoperative outcomes for ELBWIs treated for NEC, FIP, and MRI.
- To analyze trends in survival rates and neurodevelopmental status over time.
- To identify areas for improvement in surgical and postoperative care for ELBWIs.
Main Methods:
- Retrospective chart review of ELBWIs surgically treated for NEC, FIP, or MRI between 2001 and 2018.
- Categorization of the study period into early (2001-2005), middle (2006-2010), and late (2011-2018) phases.
- Statistical analysis using the Cochran-Armitage test to assess trends, with significance set at p < 0.05.
Main Results:
- Survival rates improved significantly over time for NEC and FIP, with all MRI patients surviving.
- Neuropsychological development, assessed using the Kyoto Scale, showed poor mean developmental quotients at 1.5 and 3 years corrected age.
- No significant improvement in neurodevelopmental outcomes was observed across the study periods.
Conclusions:
- While survival rates have improved for NEC and FIP in ELBWIs, optimal neuropsychological development has not been achieved.
- Less-invasive surgical techniques and enhanced postoperative care strategies are necessary to foster better neurodevelopmental outcomes.
- Continued research and clinical advancements are essential to address the complex needs of ELBWIs with these gastrointestinal disorders.
Purpose:
Necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI) are major diseases that cause gastrointestinal disorders in extremely low-birth-weight infants (ELBWIs). We conducted a review to compare the postoperative outcomes of ELBWIs with these diseases in our neonatal intensive-care unit.
Methods:
A retrospective chart review of ELBWIs surgically treated for NEC (n = 31), FIP (n = 35), and MRI (n = 16) in 2001-2018 was undertaken. This period was divided into early (2001-2005), middle (2006-2010), and late (2011-2018) periods. Data were analyzed with the Cochran-Armitage test. Statistical significance was defined as p < 0.05.
Results:
The survival rates in ELBWIs with NEC (early/middle/late: 36.4%/42.9%/61.5%; p = 0.212) and FIP (20%/50%/70.6%; p = 0.012) improved over time; all patients with MRI survived. The neuropsychological development of 24 cases was assessed with the Kyoto Scale of Psychological Development in the Postural-Motor, Cognitive-Adaptative, and Language-Social domains. The mean developmental quotient of all domains was 68.4 (range 18-95) at corrected 1.5 years of age and 69.1 (range 25-108) at chronological 3 years of age, both were considered as poor development. There was no improvement over time (p = 0.899).
Conclusion:
Ideal neuropsychological development was not observed with the improvement of survival rate. Less-invasive surgical intervention and adequate postoperative care are required to encourage further development.
