Neurodevelopment of extremely preterm infants who had necrotizing enterocolitis with or without late bacteremia

Abstract

Objective: To evaluate neurodevelopment after necrotizing enterocolitis (NEC) and late bacteremia, alone and together.

Study design: Sample included 1155 infants born at 23 to 27 weeks' gestation. NEC was classified by the modified Bell's staging criteria and grouped as medical NEC or surgical NEC. Late bacteremia was defined as a positive blood culture result after the first postnatal week. Neurodevelopment was assessed at 24 months corrected age. Multivariable models estimated the risk of developmental dysfunction and microcephaly associated with medical or surgical NEC with and without late bacteremia.

Results: Children who had surgical NEC unaccompanied by late bacteremia were at increased risk of psychomotor developmental indexes <70 (OR = 2.7 [1.2, 6.4]), and children who had both surgical NEC and late bacteremia were at increased risk of diparetic cerebral palsy (OR = 8.4 [1.9, 39]) and microcephaly (OR = 9.3 [2.2, 40]). In contrast, children who had medical NEC with or without late bacteremia were not at increased risk of any developmental dysfunction.

Conclusion: The risk of neurodevelopmental dysfunction and microcephaly is increased in children who had surgical NEC, especially if they also had late bacteremia. These observations support the hypothesis that bowel injury might initiate systemic inflammation potentially affecting the developing brain.

Figure 1

In these box and whisker displays of the distribution of MDI and PDI, the median is indicated by the vertical line close to the middle of each box and the 25^th and 75^th centiles by the sides of each box. The dispersion of the MDI and PDI scores is indicated by the length of the horizontal lines that emanate from the box, as well as by the large dots, which identify outliers. There is a box for each combination of NEC and late bacteremia.