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Comparative Study
. 2014 Jan;34(1):64-70.
doi: 10.1038/jp.2013.128. Epub 2013 Oct 17.

Neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical necrotizing enterocolitis

R Wadhawan  1 , W Oh  1 , S R Hintz  2 , M L Blakely  3 , A Das  4 , E F Bell  5 , S Saha  6 , A R Laptook  1 , S Shankaran  7 , B J Stoll  8 , M C Walsh  9 , R D Higgins  10 ; NICHD Neonatal Research Network
Collaborators, Affiliations
Comparative Study

Neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical necrotizing enterocolitis

R Wadhawan et al. J Perinatol. 2014 Jan.

Abstract

Objective: To determine if extremely low birth weight infants with surgical necrotizing enterocolitis have a higher risk of death or neurodevelopmental impairment and neurodevelopmental impairment among survivors (secondary outcome) at 18-22 months corrected age compared with infants with spontaneous intestinal perforation and infants without necrotizing enterocolitis or spontaneous intestinal perforation.

Study design: Retrospective analysis of the Neonatal Research Network very low birth weight registry, evaluating extremely low birth weight infants born between 2000 and 2005. The study infants were designated into three groups: (1) spontaneous intestinal perforation without necrotizing enterocolitis; (2) surgical necrotizing enterocolitis (Bell's stage III); and (3) neither spontaneous intestinal perforation nor necrotizing enterocolitis. Multivariate logistic regression analysis was performed to evaluate the association between the clinical group and death or neurodevelopmental impairment, controlling for multiple confounding factors including center.

Result: Infants with surgical necrotizing enterocolitis had the highest rate of death before hospital discharge (53.5%) and death or neurodevelopmental impairment (82.3%) compared with infants in the spontaneous intestinal perforation group (39.1 and 79.3%) and no necrotizing enterocolitis/no spontaneous intestinal perforation group (22.1 and 53.3%; P<0.001). Similar results were observed for neurodevelopmental impairment among survivors. On logistic regression analysis, both spontaneous intestinal perforation and surgical necrotizing enterocolitis were associated with increased risk of death or neurodevelopmental impairment (adjusted odds ratio 2.21, 95% confidence interval (CI): 1.5, 3.2 and adjusted OR 2.11, 95% CI: 1.5, 2.9, respectively) and neurodevelopmental impairment among survivors (adjusted OR 2.17, 95% CI: 1.4, 3.2 and adjusted OR 1.70, 95% CI: 1.2, 2.4, respectively).

Conclusion: Spontaneous intestinal perforation and surgical necrotizing enterocolitis are associated with a similar increase in the risk of death or neurodevelopmental impairment and neurodevelopmental impairment among extremely low birth weight survivors at 18-22 months corrected age.

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Conflict of interest statement

Disclosures

Conflict of interest disclosure: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1
Figure 1
Number of study subjects
Figure 2
Figure 2
Logistic regression analysis: Odds ratio and 95% confidence interval for NDI or death. In addition to the variables shown, center was also included in the model.
Figure 3
Figure 3
Logistic regression analysis: Odds ratio and 95% confidence interval for NDI among survivors. In addition to the variables shown, center was also included in the model.
See this image and copyright information in PMC

References

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