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

• Type of Material: Article
• Authors: Rajan Wadhawan, Brown University; William Oh, Brown University; Susan R. Hintz, Stanford University; Martin L. Blakely, Vanderbilt University; Abhik Das, RTI International; Edward F. Bell, University of Iowa; Shampa Saha, RTI International; Abbot R. Laptook, Brown University; Seetha Shankaran, Wayne State University; Barbara Stoll, Emory University; Michele C. Walsh, Case Western Reserve University; Rosemary D. Higgins, Eunice Kennedy Shriver National Institute of Child Health and Human Development
• Language: English
• Date: 2014-01-01
• Publisher: Springer Nature [academic journals on nature.com]: Hybrid Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 Nature America, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1038/jp.2013.128
• Title of Journal or Parent Work: Journal of Perinatology
• ISSN: 0743-8346
• Volume: 34
• Issue: 1
• Start Page: 64
• End Page: 70
• Grant/Funding Information: See publication for full funding statement.
• Keywords: SURGERY; neurodevelopmental impairment; necrotizing enterocolitis; extremely low birth weight; PERITONEAL DRAINAGE; spontaneous intestinal perforation; LAPAROTOMY; Pediatrics; INDOMETHACIN; COHORT; GROWTH; Obstetrics & Gynecology; Science & Technology; HEALTH; Life Sciences & Biomedicine; ASSOCIATION
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Obstetrics and Gynecology

Abstract

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.