Rate of postoperative weight gain and clinical outcomes in patients undergoing surgery for necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a life-threatening neonatal gastrointestinal emergency, characterized by a high surgical mortality rate, and growth retardation and adverse neurodevelopmental outcomes among survivors. Given these challenges, this study aimed to evaluate and analyze factors that affect the rate of postoperative weight gain in children undergoing NEC surgery, and the rate of postoperative weight gain influence on short-term clinical outcomes.

A retrospective study was conducted of infants with NEC who underwent intestinal surgery between January 1, 2014, and December 31, 2022. The patients were stratified into the low rate of weight gain (LRWG) group and high rate of weight gain (HRWG) group, with the threshold defined as an average postoperative weight gain of ≥10 g/(kg·d). Univariate and multivariate logistic regression analyses were employed to identify the risk factors associated with a LRWG. Both groups underwent comprehensive physical and neurodevelopmental assessments. Statistical analyses were performed using SPSS 26.0; a two-sided P value <0.05 was considered statistically significant.

In total, 80 patients were included in the final analysis, of whom, 45 were assigned to the LRWG group, and 35 to the HRWG group. The proximal remaining bowel length, duration of postoperative antibiotics, and time to full enteral feeding (EF) were identified as risk factors for a LRWG in the preterm infants with NEC postoperatively. The LRWG group had worse neurodevelopmental outcomes [i.e., lower Neonatal Behavioral Neurological Assessment (NBNA) scores] than the HRWG group. At 1-3 months of corrected age, the patients in the LRWG group had lower scores in terms of their fine motor skills, language proficiency, length-for-age Z-score (LAZ), weight-for-age Z-score (WAZ), head circumference-for-age Z-score (HcAZ), and ability to respond to materials and people than those in the HRWG group. A similar trend was observed at corrected ages of 4-6 and 7-12 months; that is, the patients in the LRWG group exhibited lower scores in terms of their fine motor skills, ability to respond to materials and people, WAZ, LAZ, and HcAZ than those in the HRWG group. At 13-24 months of corrected age, the patients in the LRWG group had lower scores in terms of their ability to respond to materials and people, WAZ, and HcAZ than those in the HRWG group.

A LRWG may affect the subsequent physical and central nervous system (CNS) development of infants. Therefore, optimizing intestinal length preservation and refining nutritional management are essential strategies for improving the surgical outcomes and long-term prognosis of NEC patients.