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Neurodevelopmental impairment following surgical necrotizing enterocolitis with gestational age ≥ 28 weeks: who is at risk?

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Abstract

Purpose

Surgical necrotizing enterocolitis (NEC) is a severe medical condition that, even after surgery, a portion of the survival infants may still have neurological sequelae. The objective of this study was to identify the risk factors associated with the development of permanent neurodevelopmental impairment (NDI) in neonates with surgical NEC.

Methods

Between January 2016 and June 2022, a retrospective data collection was conducted on 98 individuals who experienced surgical NEC with gestational age ≥ 28 weeks. Among these patients, 27 patients were diagnosed with NDI, while the remaining 71 patients did not have NDI. Based on this division, the patients were categorized into the NDI group and the Non-NDI group. Demographics, comorbidities, and admission lab results were analyzed using univariate and logistic regression analyses.

Results

Of the 98 neonates following surgical NEC, 27(27.6%) developed permanent neurodevelopmental impairment (NDI). Predictors of NDI were identified through the final multivariable logistic regression analysis, which revealed that gestational age ≤ 32 weeks (p = 0.032; odds ratio [OR], 5.673), assisted mechanical ventilation after NEC onset (p = 0.047; OR, 5.299), postoperative acute kidney injury (p = 0.040; OR, 5.106), CRP day 3 after NEC onset (p = 0.049; OR, 1.037), time from presentation to surgery (p = 0.003; OR, 1.047) were significant risk factors.

Conclusions

Our study identified gestational age ≤ 32 weeks, assisted mechanical ventilation after NEC onset, postoperative acute kidney injury, CRP day 3 after NEC onset, and time from presentation to surgery as significant risk factors for NDI in neonates with surgical NEC. These factors would be helpful to refine treatment modalities for better disease outcomes. We also determined the cut-off values of CRP day 3 after NEC onset and time from presentation to surgery, allowing for the individualized evaluation of NDI risk and the implementation of earlier targeted laparotomy.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

References

  1. Neu J, Walker WA (2011) Necrotizing enterocolitis. N Engl J Med 364:255–264. https://doi.org/10.1056/NEJMra1005408

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ganji N, Li B, Lee C, Pierro A (2023) Necrotizing enterocolitis: recent advances in treatment with translational potential. Pediatr Surg Int 39:205. https://doi.org/10.1007/s00383-023-05476-0

    Article  PubMed  Google Scholar 

  3. Hong CR, Han SM, Jaksic T (2018) Surgical considerations for neonates with necrotizing enterocolitis. Semin Fetal Neonatal Med 23:420–425. https://doi.org/10.1016/j.siny.2018.08.007

    Article  PubMed  Google Scholar 

  4. Han SM, Knell J, Henry O, Riley H, Hong CR, Staffa SJ, Modi BP, Jaksic T (2020) Long-term outcomes of severe surgical necrotizing enterocolitis. J Pediatr Surg 55:848–851. https://doi.org/10.1016/j.jpedsurg.2020.01.019

    Article  PubMed  Google Scholar 

  5. Schulzke SM, Deshpande GC, Patole SK (2007) Neurodevelopmental outcomes of very low-birth-weight infants with necrotizing enterocolitis: a systematic review of observational studies. Arch Pediatr Adolesc Med 161:583–590. https://doi.org/10.1001/archpedi.161.6.583

    Article  PubMed  Google Scholar 

  6. Rees CM, Pierro A, Eaton S (2007) Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed 92:F193-198. https://doi.org/10.1136/adc.2006.099929

    Article  PubMed  Google Scholar 

  7. Duci M, Fascetti-Leon F, Erculiani M, Priante E, Cavicchiolo ME, Verlato G, Gamba P (2018) Neonatal independent predictors of severe NEC. Pediatr Surg Int 34:663–669. https://doi.org/10.1007/s00383-018-4261-1

    Article  PubMed  Google Scholar 

  8. Zouari M, Ben Ameur H, Ben Saad N, Rhaiem W, Ghariani O, Ben Hamad A, Mhiri R (2023) Predictive factors for mortality in preterm neonates with necrotizing enterocolitis: a retrospective cohort study. Surg Infect 24:52–57. https://doi.org/10.1089/sur.2022.266

    Article  Google Scholar 

  9. Jen HC, Graber JJ, Hill JL, Alaish SM, Voigt RW, Strauch ED (2006) Surgical necrotizing enterocolitis and intraventricular hemorrhage in premature infants below 1000 g. J pediatr surg 41:1425–1430. https://doi.org/10.1016/j.jpedsurg.2006.04.019

    Article  PubMed  Google Scholar 

  10. Merhar SL, Ramos Y, Meinzen-Derr J, Kline-Fath BM (2014) Brain magnetic resonance imaging in infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation versus medical necrotizing enterocolitis. J Pediatr 164(410–412):e411. https://doi.org/10.1016/j.jpeds.2013.09.055

    Article  Google Scholar 

  11. Robinson JR, Kennedy C, van Arendonk KJ, Green A, Martin CR, Blakely ML (2018) Neurodevelopmental considerations in surgical necrotizing enterocolitis. Seminars Pediatr Surg 27:52–56. https://doi.org/10.1053/j.sempedsurg.2017.11.010

    Article  Google Scholar 

  12. Hickey M, Georgieff M, Ramel S (2018) Neurodevelopmental outcomes following necrotizing enterocolitis. Seminars Fetal Neonatal Med 23:426–432. https://doi.org/10.1016/j.siny.2018.08.005

    Article  Google Scholar 

  13. Zozaya C, Shah J, Pierro A, Zani A, Synnes A, Lee S, Shah PS (2021) Neurodevelopmental and growth outcomes of extremely preterm infants with necrotizing enterocolitis or spontaneous intestinal perforation. J Pediatr Surg 56:309–316. https://doi.org/10.1016/j.jpedsurg.2020.05.013

    Article  PubMed  Google Scholar 

  14. Lamireau N, Greiner E, Hascoët J-M (2023) Risk factors associated with necrotizing enterocolitis in preterm infants: a case–control study. Arch Pediatr 30:477–482. https://doi.org/10.1016/j.arcped.2023.07.003

    Article  PubMed  Google Scholar 

  15. Gitau K, Ochieng R, Limbe M, Kathomi C, Orwa J (2023) The incidence and modifiable risk factors for necrotizing enterocolitis in preterm infants: a retrospective cohort study. J Matern-Fetal Neonatal Med 36:2253351. https://doi.org/10.1080/14767058.2023.2253351

    Article  PubMed  Google Scholar 

  16. Cowap M, Stepnuk D, Stockl C, Wolfe E, Levesque M, Shawyer AC, Balshaw R, Min SAL, Keijzer R (2023) Preventing severe necrotizing enterocolitis: propensity score analysis of interventions associated with surgical NEC or NEC-associated death. J Pediatr Surg 58:828–833. https://doi.org/10.1016/j.jpedsurg.2023.01.023

    Article  PubMed  Google Scholar 

  17. Hillegass WB (2022) Brain injury in preterm infants with surgical necrotizing enterocolitis: clinical and bowel pathological correlates. Pediatr Res 91:1182–1195. https://doi.org/10.1038/s41390-021-01614-3

    Article  CAS  PubMed  Google Scholar 

  18. Matei A, Montalva L, Goodbaum A, Lauriti G, Zani A (2020) Neurodevelopmental impairment in necrotizing enterocolitis survivors: systematic review and meta-analysis. Arch Dis Child-Fetal Neonatal Ed 105:432–439. https://doi.org/10.1136/archdischild-2019-317830

    Article  PubMed  Google Scholar 

  19. Kuik SJ, van der Laan ME, Brouwer-Bergsma MT, Hulscher JB, Absalom AR, Bos AF, Kooi EM (2018) Preterm infants undergoing laparotomy for necrotizing enterocolitis or spontaneous intestinal perforation display evidence of impaired cerebrovascular autoregulation. Early Human Develop 118:25–31. https://doi.org/10.1016/j.earlhumdev.2018.01.019

    Article  Google Scholar 

  20. Fijas M, Vega M, **e X, Kim M, Havranek T (2023) SNAPPE-II and MDAS scores as predictors for surgical intervention in very low birth weight neonates with necrotizing enterocolitis. J Matern-Fetal Neonatal Med 36:2148096. https://doi.org/10.1080/14767058.2022.2148096

    Article  CAS  PubMed  Google Scholar 

  21. Shin S-H, Kim E-K, Kim S-H, Kim H-Y, Kim H-S (2021) Head growth and neurodevelopment of preterm infants with surgical necrotizing enterocolitis and spontaneous intestinal perforation. Children 8:833. https://doi.org/10.3390/children8100833

    Article  PubMed  PubMed Central  Google Scholar 

  22. Granger CL, Mukherjee K, Embleton ND, Tinnion RJ, Berrington JE (2023) Impact of transfer for surgical management of preterm necrotising enterocolitis or focal intestinal perforation. J Pediatr Surg 58:1976–1981. https://doi.org/10.1016/j.jpedsurg.2023.03.016

    Article  PubMed  Google Scholar 

  23. Bethell GS, Knight M, Hall NJ (2021) Surgical necrotizing enterocolitis: association between surgical indication, timing, and outcomes. J Pediatr Surg 56:1785–1790. https://doi.org/10.1016/j.jpedsurg.2021.04.028

    Article  PubMed  Google Scholar 

  24. Golubkova A, Hunter CJ (2023) Updates and recommendations on the surgical management of NEC. Semin Perinatol 47:151698. https://doi.org/10.1016/j.semperi.2022.151698

    Article  PubMed  Google Scholar 

  25. Garg PM, Riddick R, Ansari MAY, Pittman I, Hillegass W (2023) Clinical impact of timing of surgery on outcomes in preterm infants with surgical necrotizing enterocolitis. Res Sq. https://doi.org/10.21203/rs.3.rs-3084887/v1

    Article  PubMed  PubMed Central  Google Scholar 

  26. Garg PM, Paschal JL, Zhang M, Pippins M, Taylor C, Sanderson K, Reddy K, Askenazi D, Padbury JF, Hillegass WB (2022) Clinical impact of severe acute kidney injury on postoperative and brain injury outcomes in preterm infants following surgical necrotizing enterocolitis. J Matern-Fetal Neonatal Med 35:10124–10136. https://doi.org/10.1080/14767058.2022.2121917

    Article  CAS  PubMed  Google Scholar 

  27. Garg PM, Pittman IA, Ansari MAY, Yen CW, Riddick R, Jetton JG, South AM, Hillegass WB (2023) Gestational age-specific clinical correlates of acute kidney injury in preterm infants with necrotizing enterocolitis. Pediatr Res. https://doi.org/10.1038/s41390-023-02736-6

    Article  PubMed  Google Scholar 

  28. Hall NJ, Hiorns M, Tighe H, Peters M, Khoo AK, Eaton S, Pierro A (2009) Is necrotizing enterocolitis associated with development or progression of intraventricular hemorrhage? Am J Perinatol 26:139–143. https://doi.org/10.1055/s-0028-1095177

    Article  PubMed  Google Scholar 

  29. Li W, Zhang C, Li W, Qin F, Gao X, Xu F (2023) Nomogram for predicting fulminant necrotizing enterocolitis. Pediatr Surg Int 39:154. https://doi.org/10.1007/s00383-023-05435-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We appreciate the great help from our hospital and university.

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Authors and Affiliations

  1. Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China

    Shuai Shang, Na Geng, Yingchao Li, Suolin Li, Lintao Liu & Weili Xu

  2. Department of Pediatric Surgery, Maternity Hospital of Shijiazhuang City Affiliated to Hebei Medical University, Shijiazhuang, 050051, Hebei, China

    Shuai Shang, Ao Li & Cuncun Shen

  3. Department of Gynecology and Obstetrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China

    Lijia Du

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  1. Shuai Shang
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Contributions

Study design: WLX and SS. Data collection: SS, LTL, AL, CCS. Data analysis: SS, LJD, and WLX. Manuscript writing: SS. Manuscript critical review: WLX, NG, YCL, and SLL. All authors read and approved the final copy of the manuscript.

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Correspondence to Weili Xu.

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Shang, S., Du, L., Geng, N. et al. Neurodevelopmental impairment following surgical necrotizing enterocolitis with gestational age ≥ 28 weeks: who is at risk?. Pediatr Surg Int 40, 41 (2024). https://doi.org/10.1007/s00383-023-05628-2

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