Functional Impairments at School Age of Children With Necrotizing Enterocolitis or Spontaneous Intestinal Perforation

Abstract

ABSTRACT:We aimed to determine motor, cognitive, and behavioral outcome at school age of children who had either necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). This case-control study included infants with NEC Bell's stage IIA onward, infants with SIP, and matched controls (1996 -2002). At school age, we assessed motor skills, intelligence, visual perception, visuomotor integration, verbal memory, attention, behavior, and executive functions. Of 93 infants with NEC or SIP, 28 (30%) died. We included 52 of 65 survivors for follow-up. At mean age of 9 y, we found that 68% of the children had borderline or abnormal scores on the Movement Assessment Battery for Children (versus 45% of controls). Their mean total intelligence quotient (IQ) was 86 Ϯ 14 compared with 97 Ϯ 9 in the controls. In addition, attention and visual perception were affected (p Ͻ 0.01 and p ϭ 0.02). In comparison to controls, surgically treated children were at highest risk for adverse outcome. In conclusion, at school age, the motor functions and intelligence of many children with NEC or SIP were borderline or abnormal and, specifically, attention and visual perception were impaired. Children with NEC or SIP form a specific risk group for functional impairments at school age even though the majority does not have overt brain pathology. (Pediatr Res 70: 619-625, 2011)

Development of fine motor skills in preterm infants

“…b). Similar findings were reported by Roze et al . in a case–control study of preterm children with necrotizing enterocolitis or intestinal perforation.…”

“…c). These inflammatory conditions thus lead to a considerable increased risk of impairment of fine motor skills, with ORs between 3 and more than 5 . These studies suggest a relation between abnormal outcomes and white matter injury due to an inflammatory response …”

Surgical necrotizing enterocolitis but not spontaneous intestinal perforation is associated with adverse neurological outcome at school age

“…So far, most studies on the neurodevelopment of VLBWI reported outcome at the age of 18-36 months 17 or used data of cohorts from the 1990s 18 which are not necessarily comparable with recent cohorts who have a decreased short-term morbidity including NEC [19][20][21][22] . In one study, the authors found a reduced IQ score in children with a history of gastrointestinal disease (NEC or SIP) 11 . In our study, we made a clear distinction between surgical NEC and surgical SIP based on pathophysiological and macroscopical (as defined by attending surgeon) criteria.…”

“…In our matched cohort, we found decreased head circumferences in the NEC and SIP group. Some studies report substantial growth failure (<10 th percentile) for weight, length, and head circumference in infants with NEC 26 , but results were conflicting 11 . One study examining head biometrics in magnet resonance imaging (MRI) Figure 1.…”

Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis

“…1, 2, 3 Survivors of NEC have longer hospital stay and are at risk for long-term nutritional and neurologic problems. 4, 5, 6 A major challenge toward improving outcomes is identifying and treating infants in the early stages of NEC, when clinical signs may be subtle and nonspecific. Once more definitive signs appear, adverse outcomes such as extensive bowel necrosis leading to death or short bowel syndrome are more likely.…”