The Risk of Developing Constipation After Neonatal Necrotizing Enterocolitis

Abstract

Background: Neonatal necrotizing enterocolitis (NEC) is a complex and lethal inflammatory bowel necrosis that primarily affects premature infants. Gut dysbiosis has been implicated in the pathogenesis of NEC. We aim to assess the association between NEC and two other diseases in children, including allergic diseases and constipation, considered to be associated with the alterations in gut microbiota composition. Methods: This retrospective population-based cohort study was conducted using the Taiwan Birth Registration Database, Birth Certificate Application, and National Health Insurance Research Database to inter-link the medical claims of neonates and their mothers. A total of 2,650,634 delivery events were retrieved from 2005 to 2015. We identified a NEC cohort and selected a comparison cohort according to propensity score matching (1:1). Cox proportional hazard regression models were used to determine possible associations of predictors and to obtain adjusted hazard ratios (aHRs). Results: A total of 1,145 subjects in the NEC cohort and 1,145 subjects in the matched cohort were analyzed during the observation period. No significant difference was observed in the incidence of allergic diseases between the two groups. NEC patients had a significant 30.7% increased risk of developing constipation (aHR = 1.307; 95% CI 1.089-1.568). The cumulative incidence of constipation was significantly higher in the NEC cohort than in the matched cohort by the end of follow-up (log-rank test P = 0.003). Conclusion: Infants with NEC have a significantly higher incidence rate of developing constipation and FTT but no increased risk of allergic diseases.

Successional Stages in Infant Gut Microbiota Maturation

“…It has been reported that children with functional constipation are more likely to be born by C-section or to have a shorter duration of breastfeeding, suggesting that early gut microbiome events may increase the risk of developing functional constipation later in life (26). For instance, children with a history of necrotizing enterocolitis, who are often premature and treated with prolonged courses of antibiotics, have a higher incidence of functional constipation than healthy children (27). Infant S011 was born vaginally and was solely breastfed during the period in which constipation was reported.…”

Overview of clinical status, treatment, and long-term outcomes of pediatric autosomal-dominant polycystic kidney disease: a nationwide survey in Taiwan

“…In addition, the accuracy of the medical codes may have affected the validity of the data. To minimize diagnostic miscoding errors, we only recruited patients with at least one inpatient claim or two outpatient claims for ADPKD and related complications at least 30 days after the index date of ADPKD diagnosis 36 . However, the true incidence and complication rates of ADPKD may have been underestimated because of our strict inclusion criteria or patients not seeking medical care.…”

Toilet training and less fiber consumption as risk factors of constipation in preschool children

“…One study suggests that constipation in low birth weight infants is associated with neurological developmental disorders and may also be a secondary consequence of neonatal ischemic conditions such as necrotizing enterocolitis (Cunningham et al, 1998). Research by Shan-Ming Chen, et al also stated that constipation is associated with NEC (Chen et al, 2020).…”