Necrotizing enterocolitis as a prognostic factor for the neurodevelopmental outcome of preterm infants - match control study after 2years

Antje Allendorf; Ruth Dewitz; Joy Weber; Shahrzad Bakthiar; Rolf Schloesser; Udo Rolle

doi:10.1016/j.jpedsurg.2018.01.006

Necrotizing enterocolitis as a prognostic factor for the neurodevelopmental outcome of preterm infants - match control study after 2years

J Pediatr Surg. 2018 Aug;53(8):1573-1577. doi: 10.1016/j.jpedsurg.2018.01.006. Epub 2018 Jan 31.

Authors

Antje Allendorf¹, Ruth Dewitz², Joy Weber², Shahrzad Bakthiar¹, Rolf Schloesser¹, Udo Rolle³

Affiliations

¹ Department of Neonatology, University Hospital of the Goethe-University Frankfurt/M, Germany.
² Department of Neuropediatrics, University Hospital of the Goethe-University Frankfurt/M, Germany.
³ Department of Pediatric Surgery and Pediatric Urology, University Hospital of the Goethe-University Frankfurt/M, Germany. Electronic address: udo.rolle@kgu.de.

PMID: 29409620
DOI: 10.1016/j.jpedsurg.2018.01.006

Abstract

Purpose: Necrotizing enterocolitis (NEC) in very low birth weight infants is a risk factor for developmental delay. To our knowledge, there are no studies published investigating the neurodevelopmental outcome of patients with NEC comparing surgically treated and conservatively treated patients versus match paired controls. The aim of this retrospective case control study was to measure the neurodevelopmental outcome of patients with NEC who were treated surgically or conservatively METHODS: All patients were identified, who have been diagnosed with NEC (ICD-10 code, P77) born between 2006 and 2013. Patients with NEC received antibiotic therapy, nasogastric decompression and fasting. Surgical treatment was indicated for patients with Bell stages IIIb. We excluded patients suffering from other relevant diseases with a possible impact on their neurodevelopmental outcome (e.g., intraventricular hemorrhage, associated malformations, asphyxia, focal intestinal perforation, short bowel syndrome). Patients were tested at the corrected gestational age of 24months according to the Bayley Scales of Infant Development II. Each participant was compared to a child of the same sex, gestational age at birth (+/-two days), birth weight (+/-10%), and age at neurodevelopmental testing (IRB approval, No. 14/2014). The outcome measures were the psychomotor index (PDI) and the mental developmental index (MDI).

Results: We included 13 conservatively and 24 surgically treated patients. The patients in group A (without surgery) achieved a mean PDI of 106, and those in group B (with surgery) a mean PDI of 90. These values were significantly higher in the conservative group A. The mean MDIs were 99 in the patient group A and 85 in patient group B. This difference was also significant.

Conclusion: We found significantly lower MDIs and PDIs in children with surgical treatment of NEC. Further systematic prospective research on the prevention of NEC and systematic follow-ups at later stages in the patients' development are necessary in order to implement early intervention.

Type of study: case control study.

Level of evidence: III.

Keywords: Follow-up; NEC; Neurodevelopment.

MeSH terms

Birth Weight
Case-Control Studies
Developmental Disabilities / etiology
Enterocolitis, Necrotizing / complications*
Enterocolitis, Necrotizing / surgery
Female
Gestational Age
Humans
Infant, Newborn
Infant, Premature*
Intestinal Perforation / complications*
Intestinal Perforation / surgery
Male
Neurologic Examination
Prognosis
Retrospective Studies
Short Bowel Syndrome / complications