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Published on: November 20, 2015
Risk of neurodevelopmental impairment in Swedish preterm children treated for necrotizing enterocolitis:
Nele Brusselaers1,2,3, Johanna Simin2, Helene E Lilja1,4
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Preterm infants treated for necrotizing enterocolitis (NEC), either medically or surgically, face a higher risk of neurodevelopmental disorders. Abdominal surgery for other conditions also increases this risk compared to preterm infants without these interventions.
Area of Science:
- Neonatal care
- Pediatric neurology
- Surgical outcomes
Background:
- Increasing survival rates of preterm infants necessitate focus on long-term neurodevelopmental outcomes.
- Necrotizing enterocolitis (NEC) is a significant concern in preterm infants, with potential long-term neurological sequelae.
- Understanding the neurodevelopmental risks associated with NEC treatment is crucial for improved infant care.
Purpose of the Study:
- To investigate the risk of neurodevelopmental disorders in preterm infants treated for necrotizing enterocolitis (NEC).
- To compare neurodevelopmental outcomes between medically and surgically treated NEC infants.
- To compare NEC-related neurodevelopmental risks with those from abdominal surgery for other indications in preterm infants.
Main Methods:
- Nationwide Swedish cohort study of liveborn preterm infants (1998-2019).
- Assessed risk of attention deficit (hyperactivity) disorder, autism spectrum disorders, cerebral palsy, and intellectual disability.
- Utilized multivariable Cox regression to calculate hazard ratios and 95% confidence intervals.
Main Results:
- Surgically treated NEC infants had a 32% incidence of neurodevelopmental disorders (HR 2.24).
- Medically treated NEC infants had a 22% incidence (HR 1.40).
- Abdominal surgery for other indications showed a 21% incidence (HR 1.63), while the reference group had 13%.
Conclusions:
- All forms of necrotizing enterocolitis (medical and surgical) and abdominal surgery for other indications in preterm infants are linked to increased neurodevelopmental impairment risks.
- Surgical NEC and general abdominal surgery showed the highest relative increases in intellectual disability and cerebral palsy.
- Medically treated NEC was associated with autism, while both surgical NEC and general abdominal surgery groups showed associations with ADHD and autism.
Background:
As the survival of preterm infants has increased, the management of long-term complications, especially neurodevelopmental impairment, becomes increasingly important. The aim of this study was to investigate the risk of neurodevelopmental disorders in preterm babies receiving medical or surgical treatment for necrotizing enterocolitis, compared with other preterm babies and preterm babies who received abdominal surgery for other indications.
Methods:
In this nationwide Swedish cohort study, including all liveborn preterm babies born between 1998 and 2019, the risk of attention deficit (and hyperactivity) disorder, autism spectrum disorders, cerebral palsy and intellectual disability was assessed by multivariable Cox regression, expressed as hazard ratios and 95% confidence intervals (c.i.).
Results:
Of the surgically (n = 384) and medically (n = 709) treated preterm infants with necrotizing enterocolitis, neurodevelopmental disorders were present in 32% (HR 2.24, 95% c.i. 1.86 to 2.69) and 22% respectively (HR 1.40, 95% c.i. 1.19 to 1.65), compared with 21% (HR 1.63, 95% c.i. 1.40 to 1.91) in the abdominal surgery group (n = 844) and 13% (reference) among other preterm infants (n = 78 972). The highest relative increases were for intellectual disability (HR 3.60, 95% c.i. 2.65 to 4.89) in the surgical necrotizing enterocolitis group and abdominal surgery group (HR 2.84, 95% c.i. 2.12 to 3.80) compared with the control preterm group, and for cerebral palsy (respectively HR 2.74, 95% c.i. 2.04 to 3.68 and HR 2.54, 95% c.i. 1.87 to 3.44). Medically treated necrotizing enterocolitis was associated with autism (HR 1.67, 95% c.i. 1.34 to 2.08), without significant increases for the other specific outcomes. Both surgically treated groups were also strongly associated with both attention deficit (and hyperactivity) disorder and autism.
Conclusion:
Surgically treated necrotizing enterocolitis, medically treated necrotizing enterocolitis and abdominal surgery for other indications in preterm infants were all associated with an increased risk of impaired neurodevelopmental outcomes, compared with other preterm infants.
