Neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical necrotizing enterocolitis

• Published in: Journal of perinatology Vol. 34; no. 1; pp. 64 - 70
• Main Authors: Wadhawan, R, Oh, W, Hintz, S R, Blakely, M L, Das, A, Bell, E F, Saha, S, Laptook, A R, Shankaran, S, Stoll, B J, Walsh, M C, Higgins, R D
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.01.2014; Nature Publishing Group
• Subjects: 692/699/1503/1581; 692/699/375/366; 692/700/1720; Birth weight; Birth weight, Low; Child Development; Child development deviations; Childrens health; Complications and side effects; Developmental disabilities; Developmental Disabilities - etiology; Enterocolitis; Enterocolitis, Necrotizing - complications; Enterocolitis, Necrotizing - surgery; Epidemiology; Female; Follow-Up Studies; Gastrointestinal diseases; Hospitals; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Injuries; Intestinal Perforation - complications; Intestines; Logistic Models; Medicine; Medicine & Public Health; original-article; Pediatric Surgery; Pediatrics; Physiological aspects; Pregnancy; Regression analysis; Retrospective Studies; Risk factors; Socioeconomic Factors; Steroids - therapeutic use; Young Adult; Atlanta Georgia; United States > US; spontaneous intestinal perforation; necrotizing enterocolitis; neurodevelopmental impairment; extremely low birth weight
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2013.128

Objective: To determine if extremely low birth weight infants with surgical necrotizing enterocolitis have a higher risk of death or neurodevelopmental impairment and neurodevelopmental impairment among survivors (secondary outcome) at 18–22 months corrected age compared with infants with spontaneous intestinal perforation and infants without necrotizing enterocolitis or spontaneous intestinal perforation. Study Design: Retrospective analysis of the Neonatal Research Network very low birth weight registry, evaluating extremely low birth weight infants born between 2000 and 2005. The study infants were designated into three groups: (1) spontaneous intestinal perforation without necrotizing enterocolitis; (2) surgical necrotizing enterocolitis (Bell's stage III); and (3) neither spontaneous intestinal perforation nor necrotizing enterocolitis. Multivariate logistic regression analysis was performed to evaluate the association between the clinical group and death or neurodevelopmental impairment, controlling for multiple confounding factors including center. Result: Infants with surgical necrotizing enterocolitis had the highest rate of death before hospital discharge (53.5%) and death or neurodevelopmental impairment (82.3%) compared with infants in the spontaneous intestinal perforation group (39.1 and 79.3%) and no necrotizing enterocolitis/no spontaneous intestinal perforation group (22.1 and 53.3%; P <0.001). Similar results were observed for neurodevelopmental impairment among survivors. On logistic regression analysis, both spontaneous intestinal perforation and surgical necrotizing enterocolitis were associated with increased risk of death or neurodevelopmental impairment (adjusted odds ratio 2.21, 95% confidence interval (CI): 1.5, 3.2 and adjusted OR 2.11, 95% CI: 1.5, 2.9, respectively) and neurodevelopmental impairment among survivors (adjusted OR 2.17, 95% CI: 1.4, 3.2 and adjusted OR 1.70, 95% CI: 1.2, 2.4, respectively). Conclusion: Spontaneous intestinal perforation and surgical necrotizing enterocolitis are associated with a similar increase in the risk of death or neurodevelopmental impairment and neurodevelopmental impairment among extremely low birth weight survivors at 18–22 months corrected age.