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Comparing Healthcare Needs in Extremely Low Birth Weight Infants With NEC and Spontaneous Intestinal Perforation
Priyanka V Chugh1, Emily Nes1, Katherine Culbreath1
1Boston Children's Hospital, Department of Surgery, Boston, MA, USA.
Journal of Pediatric Surgery
|April 1, 2024
Summary
Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants both increase risks for neurodevelopmental issues and healthcare needs. NEC poses a higher risk for severe neurodevelopmental disability and post-discharge surgery compared to SIP.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Developmental Pediatrics
Background:
- Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) affect 6-8% of extremely low birth weight (ELBW) infants.
- While SIP has lower mortality than NEC, both conditions present similar short-term morbidities.
- Long-term neurodevelopmental outcomes following NEC and SIP in ELBW infants remain unclear.
Purpose of the Study:
- To compare the long-term neurodevelopmental and healthcare outcomes of ELBW infants with laparotomy-confirmed NEC versus SIP.
- To assess the risks of severe neurodevelopmental disability, growth failure, rehospitalization, and post-discharge surgical needs.
Main Methods:
- Prospective data collection from 59 North American neonatal units for ELBW infants (401-1000g or 22-27 weeks gestational age) born 2011-2018.
- Follow-up evaluations at 16-26 months corrected age for infants with confirmed NEC, SIP, and controls.
- Primary outcome: severe neurodevelopmental disability. Secondary outcomes: weight <10th percentile, medical readmission, post-discharge surgery, and home medical support.
Main Results:
- No statistically significant differences in overall outcomes when directly comparing NEC to SIP.
- Infants with NEC showed a significantly higher risk of severe neurodevelopmental disability (ARR 1.43) and rehospitalization (ARR 1.46) compared to controls.
- Infants with NEC (ARR 1.82) and SIP (ARR 1.64) both had increased risks of post-discharge surgery compared to controls.
Conclusions:
- ELBW infants with NEC face significantly increased risks for severe neurodevelopmental disability and greater post-discharge healthcare needs.
- ELBW infants with SIP also experience increased healthcare needs, particularly regarding post-discharge surgery.
- These findings highlight the importance of long-term monitoring for both NEC and SIP survivors.
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