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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
PubMed

Insights

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.
Abstract

Keywords:
NICUNecrotizing enterocolitisNeurodevelopmentPrematuritySpontaneous intestinal perforation

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