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Multicenter Study
. 2024 Sep 1;280(3):432-443.
doi: 10.1097/SLA.0000000000006378. Epub 2024 Jun 7.

Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants

Allison L Speer  1 , Kevin P Lally  1 , Claudia Pedroza  2 , Yuxin Zhang  2 , Brenda B Poindexter  3 , Walter J Chwals  4 , Susan R Hintz  5 , Gail E Besner  6 , David K Stevenson  5 , Robin K Ohls  7   8 , William E Truog  9 , Barbara J Stoll  3 , Matthew A Rysavy  2 , Abhik Das  10 , Jon E Tyson  2 , Martin L Blakely  1 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Multicenter Study

Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants

Allison L Speer et al. Ann Surg. .

Abstract

Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure.

Summary background data: Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited.

Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <-2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables.

Results: Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P=0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2).

Conclusions: This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months.

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Conflict of interest statement

Disclosures/Conflicts of Interest:

Gail E. Besner is the Scientific Co-Founder of Scioto Biosciences, Inc.

Figures

Figure 1:
Figure 1:. Patient Flow Diagram.
Extremely low birthweight (ELBW) infants with surgical spontaneous intestinal perforation (SIP) or necrotizing enterocolitis (NEC) survival and follow-up.
Figure 2:
Figure 2:. Growth failure is common in infants with surgical NEC or SIP, especially in patients with NEC treated with initial peritoneal drain placement.
Growth failure is defined as a Z-score <−2.0 (below horizontal red line). Z-scores for weight (A), length (B), and head circumference (C) at birth, initial surgery*, 36-weeks postmenstrual age (PMA), and 18–22 months corrected age are shown for infants with NEC and SIP who underwent initial laparotomy (Lap) or peritoneal drain (Drain). *At the initial surgery, only weight measurements were collected. Z-score median and IQR shown with boxplot. Z-score mean and SD shown with blue point and lines.
See this image and copyright information in PMC

References

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