Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes

Abstract

Introduction To improve counseling of parents and to guide care strategies, we studied the disease course and outcomes of necrotizing enterocolitis (NEC) up to 2 years of corrected age (CA) from a multidisciplinary perspective. Materials and Methods This was a retrospective cohort study in preterm infants (birth weight < 1,500 g, gestational age < 32 weeks), diagnosed with NEC (Bell's stage ≥ II) from 2008 through 2020. Data on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up were separately analyzed for medically and surgically treated children. Results Of 3,456 preterm infants, 200 (6%) were diagnosed with NEC, of whom 135 developed an indication for surgery within 7 days after the diagnosis; 28/135 died before surgery, and 37/107 died after an open-and-close procedure. An enterostomy was constructed in 62 patients and an end-to-end anastomosis in 15. The postoperative course was described for 77 patients, of whom 23 developed surgical complications (12/23 incisional hernias, 9/23 anastomotic strictures), 13/77 a short bowel, and 25/77 IF. Sixty-day survival after birth for medical NEC patients was 88% (hazard ratio [HR]: 0.698; p = 0.318), and for surgically treated NEC patients was 40% (HR: 3.729; p < 0.001). At 2-year follow-up, one patient received parenteral nutrition. Severe delay in weight for age, motor, and cognitive development was seen in 3, 6, and 2%, respectively. Conclusion In this cohort, the mortality rate was high, especially in surgically treated NEC patients. The surgical complication rate is comparable to previous studies, but in surviving patients, persisting IF and severe delay in growth and neurodevelopment at 2 years CA were relatively rare.

Cognitive assessment in preterms by Bayley-III: development in the first year and associated factors

“…Surviving preterm infants with a history of NEC stage II or higher are at risk for long-term neurodevelopmental impairment. 22 At six months, we observed that the control group was significantly older than the preterm group, with a difference of 11 days, on average. However, as the Bayley-III composite score was pre-adjusted for age and the infants were tested to their maximum level, we determined that this difference did not affect the interpretation of the results.…”

Limosilactobacillus reuteri in immunomodulation: molecular mechanisms and potential applications

“…Necrotizing enterocolitis (NEC) is a fatal acute inflammatory disease of the intestine that tends to occur in newborns, especially preterm infants ( 148 ), with a high incidence rate ( 149 , 150 ). The risk factors of NEC include premature delivery, no breastfeeding ( 151 ), increased antibiotic exposure ( 152 ), and intestinal microbial ecological imbalance ( 153 ).…”

Selective targeting of MD2 attenuates intestinal inflammation and prevents neonatal necrotizing enterocolitis by suppressing TLR4 signaling

“…A cohort study of 9,552 premature infants with gestational age less than 32 weeks found that the incidence of NEC was 4.9% based on data collected from 57 tertiary hospitals in 25 provinces of China in 2019 (4). The common long-term and severe complications of the NEC survivors included delayed neuropsychomotor development, short bowel syndrome, cholestasis, intestinal failure and intestinal stenosis (5)(6)(7). Although NEC etiology and pathogenesis are not clearly understood, studies have shown that exaggerated inflammatory signal imbalance in the intestinal mucosa and intestinal injury work together to induce NEC in premature infants (8).…”