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Cognitive Outcomes in Children With Conditions Affecting the Small Intestine: A Systematic Review and Meta-analysis
Lotte E Vlug1, Merel W Verloop2, Bram Dierckx2
1Division of Gastroenterology, Department of Pediatrics.
Insights
Children with intestinal failure (IF) and necrotizing enterocolitis (NEC) often experience adverse cognitive outcomes. Monitoring and intervention are crucial for children with small intestine conditions requiring parenteral nutrition.
Area of Science:
- Pediatric Gastroenterology
- Neurodevelopmental Pediatrics
- Clinical Pediatrics
Background:
- Children with intestinal failure (IF) and related conditions requiring parenteral nutrition (PN) are at risk for neurodevelopmental deficits.
- Cognitive outcomes in these vulnerable populations require thorough investigation to inform clinical practice.
Purpose of the Study:
- To assess cognitive outcomes, including developmental quotient (DQ), intelligence quotient (IQ), and rates of severe developmental delay/disability (SDD), in children with IF and those at high risk.
- To compare cognitive performance across different pediatric gastrointestinal conditions: IF, surgical necrotizing enterocolitis (NEC), abdominal wall defects (AWD), and midgut malformations (MM).
Main Methods:
- A systematic literature search was conducted across multiple databases (EMBASE, Cochrane, Web of Science, Google Scholar, MEDLINE, PsycINFO) up to October 2020.
- Random effects meta-analyses were performed to pool DQ/IQ scores and SDD rates for the identified patient groups.
- Meta-regressions were used to explore associations between patient characteristics (e.g., gestational age, hospital stay, surgeries, PN duration) and cognitive outcomes.
Main Results:
- Thirty studies met the inclusion criteria, providing data on cognitive outcomes.
- Pooled mean DQ/IQ scores were lowest for IF (86.8) and NEC (83.3), while AWD (96.6) and MM (99.5) showed scores closer to the general population mean.
- Pooled SDD rates were significantly elevated in IF (28.6%) and NEC (32.8%) compared to AWD (8.5%) and MM (3.7%). Lower gestational age, longer hospital stay, and more surgeries were linked to lower DQ/IQ.
Conclusions:
- Adverse developmental outcomes are prevalent in children with IF and NEC, necessitating close monitoring of cognitive development.
- Children with AWD and MM also show cognitive deficits, though to a lesser extent than IF and NEC groups.
- Proactive strategies for prevention and remediation of cognitive impairments are essential for children with small intestine conditions requiring PN.
Objectives:
The aim of the study was to assess cognitive outcomes in children with intestinal failure (IF) and children at high risk of IF with conditions affecting the small intestine requiring parenteral nutrition.
Methods:
EMBASE, Cochrane, Web of Science, Google Scholar, MEDLINE, and PsycINFO were searched from inception to October 2020. Studies were included constituting original data on developmental quotient (DQ), intelligence quotient (IQ) and/or severe developmental delay/disability (SDD) rates assessed with standardized tests. We used appropriate standardized tools to extract data and assess study quality. We performed random effects meta-analyses to estimate pooled means of DQ/IQ and pooled SDD rates (general population mean for DQ/IQ: 100, for percentage with SDD: 1.8%) for 4 groups: IF, surgical necrotizing enterocolitis (NEC), abdominal wall defects (AWD), and midgut malformations (MM). Associations of patient characteristics with DQ/IQ were evaluated with meta-regressions.
Results:
Thirty studies met the inclusion criteria. The pooled mean DQ/IQ for IF, NEC, AWD, and MM were 86.8, 83.3, 96.6, and 99.5, respectively. The pooled SDD rates for IF, NEC, AWD and MM were 28.6%, 32.8%, 8.5%, and 3.7%, respectively. Meta-regressions indicated that lower gestational age, longer hospital stay, and higher number of surgeries but not parenteral nutrition duration, were associated with lower DQ/IQ.
Conclusions:
Adverse developmental outcomes are common in children with IF and NEC, and to a much lesser extent in children with AWD and MM. It is important to monitor cognitive development in children with conditions affecting the small intestine and to explore avenues for prevention and remediation.
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