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. 2021 Jan;41(1):150-156.
doi: 10.1038/s41372-020-00880-z. Epub 2020 Dec 2.

Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis

Kera McNelis  1   2 , Gillian Goddard  3   4 , Todd Jenkins  3 , Anne Poindexter  5   3 , Jacqueline Wessel  3 , Michael Helmrath  5   3 , Brenda Poindexter  6   7
Affiliations

Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis

Kera McNelis et al. J Perinatol. 2021 Jan.

Abstract

Objective: To understand the nutritional intake and growth outcomes of very low birth weight infants with surgical necrotizing enterocolitis (NEC).

Study design: In a retrospective cohort study, linear mixed models were used to compare growth outcomes from birth to 24 months corrected age for very low birth weight (VLBW) infants with surgical NEC to those with spontaneous intestinal perforation (SIP). Kaplan-Meier curves were developed to demonstrate the duration of parenteral nutrition (PN) use.

Result: Height differed by surgical NEC and SIP over time (interaction p = 0.03). Surviving infants with surgical NEC had lower head circumference z-scores at 24 months. Of infants surviving surgical NEC, 71% received PN for >60 days after diagnosis.

Conclusion: The majority of infants with surgical NEC have a delay in achieving enteral autonomy. There was a difference in linear catch-up growth over time between infants with SIP and surgical NEC at 24 months.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Flow diagram of study subject selection.
Potentially eligible subjects were generated through billing codes. Manual chart review was completed with exclusion of ineligible infants.
Fig. 2
Fig. 2. Duration of parenteral nutrition exposure after diagnosis of necrotizing enterocolitis or spontaneous intestinal perforation.
This Kaplan-Meier curve displays duration of parenteral nutrition exposure (days) in 19 very low birth weight (VLBW) infants diagnosed with spontaneous intestinal perforation, 43 VLBW infants with medical necrotizing enterocolitis (NEC), and 14 VLBW infants with surgical NEC. Included infants survived to hospital discharge.
Fig. 3
Fig. 3. Change in weight z-scores in very low birth weight infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation from birth through hospital discharge and follow up at 24 months corrected age.
Z-scores were calculated using the Fenton growth chart through 50 weeks corrected age and World Health Organization growth charts thereafter [9, 10]. Linear mixed models were used to compare longitudinal weight outcomes by surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) groupings. Modeled means and 95% confidence intervals were calculated by NEC/SIP status and study visit.
Fig. 4
Fig. 4. Change in height z-scores in very low birth weight infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation from birth through hospital discharge and follow up at 24 months corrected age.
Z-scores were calculated using the Fenton growth chart through 50 weeks corrected age and World Health Organization growth charts thereafter [9, 10]. Linear mixed models were used to compare longitudinal height outcomes by surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) groupings. Modeled means and 95% confidence intervals were calculated by NEC/SIP status and study visit.
Fig. 5
Fig. 5. Change in head circumference z-scores in very low birth weight infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation from birth through hospital discharge and follow up at 24 months corrected age.
Z-scores were calculated using the Fenton growth chart through 50 weeks corrected age and World Health Organization growth charts thereafter [9, 10]. Linear mixed models were used to compare longitudinal head circumference outcomes by surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) groupings. Modeled means and 95% confidence intervals were calculated by NEC/SIP status and study visit.
See this image and copyright information in PMC

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