Comparing Healthcare Needs in Extremely Low Birth Weight Infants With NEC and Spontaneous Intestinal Perforation

Priyanka V Chugh; Emily Nes; Katherine Culbreath; Gregory Keefe; Erika M Edwards; Kate A Morrow; Danielle Ehret; Roger F Soll; Biren P Modi; Jeffrey D Horbar; Tom Jaksic

doi:10.1016/j.jpedsurg.2024.03.006

Comparing Healthcare Needs in Extremely Low Birth Weight Infants With NEC and Spontaneous Intestinal Perforation

J Pediatr Surg. 2024 Mar 16:S0022-3468(24)00157-X. doi: 10.1016/j.jpedsurg.2024.03.006. Online ahead of print.

Authors

Affiliations

¹ Boston Children's Hospital, Department of Surgery, Boston, MA, USA.
² University of Vermont, Department of Mathematics and Statistics, Burlington, VT, USA; Vermont Oxford Network, Burlington, VT, USA.
³ Vermont Oxford Network, Burlington, VT, USA.
⁴ Vermont Oxford Network, Burlington, VT, USA; University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA.
⁵ Boston Children's Hospital, Department of Surgery, Boston, MA, USA. Electronic address: Tom.jaksic@childrens.harvard.edu.

PMID: 38561308
DOI: 10.1016/j.jpedsurg.2024.03.006

Abstract

Background: Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) affect 6-8% of extremely low birth weight (ELBW) infants. SIP has lower mortality than NEC, but with similar short-term morbidity in length of stay, growth failure, and supplemental oxygen requirements. Comparative long-term neurodevelopmental outcomes have not been clarified.

Methods: Data were prospectively collected from 59 North American neonatal units, regarding ELBW infants (401-1000 g or 22-27 weeks gestational age) born between 2011 and 2018 and evaluated again at 16-26 months corrected age. Outcomes were collected from infants with laparotomy-confirmed NEC, laparotomy-confirmed SIP, and those without NEC or SIP. The primary outcome was severe neurodevelopmental disability. Secondary outcomes were weight <10th percentile, medical readmission, post-discharge surgery and medical support at home. Adjusted risk ratios (ARR) were calculated.

Results: Of 13,673 ELBW infants, 6391 (47%) were followed including 93 of 232 (40%) with NEC and 100 of 235 (42%) with SIP. There were no statistically significant differences in adjusted risk of any outcomes when directly comparing NEC to SIP (ARR 2.35; 95% CI 0.89, 6.26). However, infants with NEC had greater risk of severe neurodevelopmental disability (ARR 1.43; 1.09-1.86), rehospitalization (ARR 1.46; 1.17-1.82), and post-discharge surgery (ARR 1.82; 1.48-2.23) compared to infants without NEC or SIP. Infants with SIP only had greater risk of post-discharge surgery (ARR 1.64; 1.34-2.00) compared to infants without NEC or SIP.

Conclusions: ELBW infants with NEC had significantly increased risk of severe neurodevelopmental disability and post-discharge healthcare needs, consistent with prior literature. We now know infants with SIP also have increased healthcare needs.

Levels of evidence: Level II.

Keywords: NICU; Necrotizing enterocolitis; Neurodevelopment; Prematurity; Spontaneous intestinal perforation.