Hospital and neurodevelopmental outcomes of extremely low-birth-weight infants with necrotizing enterocolitis and spontaneous intestinal perforation

Abstract

Objective: We sought to determine the incidence of necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in surviving extremely low-birth-weight (ELBW, <1000 g birth weight) infants and to establish the impact of NEC on outcomes by hospital discharge and at 18 to 22 months adjusted age in a large, contemporary, population-based practice.Study Design: Hospital outcome data for all ELBW infants born in the greater Cincinnati region from 1998 to 2009 were extracted from the National Institute of Child Health Neonatal Research Network Database. Neurodevelopmental outcome at 18 to 22 months was assessed using Bayley Scales of Infant Development-II scores for Mental Developmental Index and Psychomotor Developmental Index. Multivariable logistic regression was used and adjusted odds ratios reported to control for confounders.Result: From 1998 to 2009, ELBW infants accounted for 0.5% of the 352 176 live-born infants in greater Cincinnati. The incidence of NEC was 12%, with a 50% case-fatality rate. Death before discharge, morbid complications of prematurity and neurodevelopmental impairment were all increased among infants diagnosed with NEC. Infants with surgical NEC and SIP had a higher incidence of death, but long-term neurodevelopmental outcomes were not different comparing surviving ELBW infants with medical NEC, surgical NEC and SIP.Conclusion: Although ELBW infants comprise a very small proportion of live-born infants, those who develop NEC and SIP are at an increased risk for death, morbid complications of prematurity and neurodevelopmental impairment. No significant differences in neurodevelopmental outcomes were observed between the medical and surgical NEC and SIP groups. Journal of Perinatology (2012) 32, 552-558; doi:10.1038/jp.2011.176; published online 8 December 2011Keywords: necrotizing enterocolitis; extremely low-birth-weight; neurodevelopmental outcome; Bayley scales of infant development Introduction Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease with significant mortality and morbidity predominantly affecting preterm infants. 1,2 Extremely low-birth-weight (ELBW) infants (birth weight p1000 g) and infants with gestation <28 weeks are most susceptible. Despite advances in neonatal and perinatal medicine that have enabled the survival of increasing numbers of ELBW infants, the incidence (5 to 11%) and mortality rate (15 to 25%) for ELBW infants with NEC has not improved over the past 30 years. 2-5 Increasingly, extremely premature infants are surviving early problems of prematurity only to succumb to later complications, specifically NEC. 6 Outcome studies indicate that many ELBW infants with NEC who receive medical treatment have longer-term outcomes similar to infants without NEC of matched gestational age. Infants with progressive disease requiring surgical intervention exhibit higher rates of mortality (30 to 40%) and suffer the preponderance of neurodevelopmental morbidities. 2,7,8 Spontaneous intestinal perforation (SIP) is an acquired form of neonat...

Surgical Necrotizing Enterocolitis versus Spontaneous Intestinal Perforation in White Matter Injury on Brain Magnetic Resonance Imaging

“…Recent studies have reported no differences in neurodevelopmental outcomes between SIP and surgNEC [9,10]. In a larger study of extremely low birth weight infants from the Neonatal Research Network database, there were no differences in neurodevelopmental outcomes at 18-22 months of corrected age between the surgNEC group and the SIP group [10].…”

“…There have been studies demonstrating that preterm infants with SIP show adverse long-term neurodevelopmental outcomes similar to those of infants with NEC [9,10]. However, compared to NEC, SIP has a relatively stable clinical manifestation [11].…”

Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012–13: a whole-population surveillance study

“…[6][7][8][9][10] Among infants <32w GA or <1500g birth weight, around a third proceed to laparotomy (around 60% among the most immature). Overall mortality is around a third, rising to 50% following laparotomy.…”

“…Overall mortality is around a third, rising to 50% following laparotomy. 6,10 Variations in feeding practices are widely believed to influence the risk of NEC. Japan has the lowest reported rate, attributed to early and "aggressive" enteral feeding and high use of unpasteurized Human Donor Milk (HDM) though these practices have not been investigated with rigour.…”

“…Comparisons with other population based studies are hampered by the differences in case-definitions and inclusion criteria 6,10,[28][29][30][31] In the United Kingdom there have been two studies in the last decade, EPICure 2, 30 restricted to neonates born up to 26 weeks GA, and a four month prevalence study with a low response rate. 23 Wide global variation is reported in the rate of NEC of all grades of severity, but our rates for laparotomy and mortality are similar to published data from Canada, 32,33 Australia 6 , and the United States.…”