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. 2024;17(5):705-716.
doi: 10.3233/NPM-240022.

Clinical correlates of cerebellar injury in preterm infants with surgical necrotizing enterocolitis

P M Garg  1   2 , I Pittman  2 , J Yi  3 , A Shetty  4 , C Taylor  5 , K Reddy  5 , T E Inder  6 , N Varshney  7 , W B Hillegass  8   9 , P P Garg  2
Affiliations

Clinical correlates of cerebellar injury in preterm infants with surgical necrotizing enterocolitis

P M Garg et al. J Neonatal Perinatal Med. 2024.

Abstract

Background: The preterm infants are at risk of cerebellar injury and the risk factors for necrotizing enterocolitis (NEC) associated cerebellar injury are not fully understood.

Aim: Determine the risk factors of cerebellar injury in infants with surgical necrotizing enterocolitis (NEC).

Methods: Retrospective study compared clinical/pathological information between surgical NEC infants with and those without cerebellar injury detected on brain MRI obtained at term equivalent age. Cerebellar Injury patterns that we identified on MRI brain were cerebellar hemorrhage, siderosis and/or cerebellar volume loss.

Results: Cerebellar injury (21/65, 32.3%) in preterm infants with NEC was associated with patent ductus arteriosus (PDA) (18/21(85.7%) vs. 25/44(56.8%); p = 0.021), blood culture positive sepsis (13/21 (61.9%) vs. 11/44 (25%); p = 0.004) following NEC, predominantly grew gram positive bacteria (9/21(42.9%) vs. 4/44(9.1%); p = 0.001), greater red cell transfusion, higher rates of cholestasis following NEC and differences in intestinal histopathology (more hemorrhagic and reparative lesions) on univariate analysis. Those with cerebellar injury had higher grade white matter injury (14/21 (66.7%) vs. 4/44(9.1%) p = 0.0005) and higher-grade ROP (70.6% vs. 38.5%; p = 0.027) than those without cerebellar injury.On multilogistic regression, the positive blood culture sepsis (OR 3.9, CI 1.1-13.7, p = 0.03), PDA (OR 4.5, CI 1.0-19.9, p = 0.04) and severe intestinal pathological hemorrhage (grade 3-4) (OR 16.9, CI 2.1-135.5, p = 0.007) were independently associated with higher risk of cerebellar injury.

Conclusion: Preterm infants with surgical NEC with positive blood culture sepsis, PDA, and severe intestinal hemorrhagic lesions (grade 3-4) appear at greater risk for cerebellar injury.

Keywords: Brain injury; cerebellar lesions; neonate; preterm infant; surgical NEC.

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Conflict of interest statement

Conflicts of interest: The authors disclose no conflicts.

Figures

Figure 1:
Figure 1:
Patient flow algorithm for included, excluded, and enrolled infants with surgical necrotizing enterocolitis.
Figure 2:
Figure 2:. Cerebellar injury on MRI.
A. Coronal T2 weighted MRI shows mild right cerebellar volume loss (arrow) contralateral to a large porencephalic cyst (star) in this patient with prior grade 4 germinal matrix hemorrhage. B. Coronal T2 MRI shows severe bilateral cerebellar volume loss (arrows) in this patient who also had a severe brain injury in the supratentorial brain. C. Axial SWI MRI shows few small hemorrhages in the left cerebellar hemisphere (white arrowheads) and superficial siderosis coating the surface of the brainstem and cerebellum (black arrowheads). D. Axial GRE shows multiple bilateral hemorrhages in the cerebellum.
See this image and copyright information in PMC

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References

    1. Sjoberg Bexelius T, Ahle M, Elfvin A, Bjorling O, Ludvigsson JF, Andersson RE. Intestinal failure after necrotising enterocolitis: incidence and risk factors in a Swedish population-based longitudinal study. BMJ paediatrics open. 2018;2(1):e000316. - PMC - PubMed
    1. Allin BSR, Long AM, Gupta A, Lakhoo K, Knight M. One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study. Archives of disease in childhood Fetal and neonatal edition. 2018;103(5):F461–f6. - PMC - PubMed
    1. Knell J, Han SM, Jaksic T, Modi BP. Current Status of Necrotizing Enterocolitis. Curr Probl Surg. 2019;56(1):11–38. - PubMed
    1. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012. Jama. 2015;314(10):1039–51. - PMC - PubMed
    1. Santulli TV, Schullinger JN, Heird WC, Gongaware RD, Wigger J, Barlow B, et al. Acute necrotizing enterocolitis in infancy: a review of 64 cases. Pediatrics. 1975;55(3):376–87. - PubMed

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