Dataset Information

Brain injury in preterm infants with surgical necrotizing enterocolitis: clinical and bowel pathological correlates.

ABSTRACT:

Background

The objective of this study was to determine the risk factors and outcomes of white matter brain injury (WMBI) on magnetic resonance imaging (MRI) at term-equivalent age in infants with surgical necrotizing enterocolitis (NEC).

Methods

This retrospective study compared clinical/pathological information between infants with and those without WMBI.

Results

Out of 69 infants with surgical NEC, 17 (24.6%) had mild WMBI, 13 (18.8%) had moderate WMBI, and six (8.7%) had severe WMBI on the brain MRI. Several clinical factors (gestational age, more red blood cell (RBC) transfusions before NEC onset, pneumoperitoneum, earlier NEC onset age, postoperative ileus, acute kidney injury (AKI) by serum creatinine, postnatal steroids, hospital stay) and histopathological findings (necrosis, hemorrhage) had univariate associations with WMBI. Associations with RBC transfusion (odds ratio (OR) 23.6 [95% confidence interval (CI): 4.73-117.97]; p = 0.0001), age at NEC onset (OR 0.30 [95%CI: 0.11-0.84]; p = 0.021), necrosis (OR 0.10 [95%CI: 0.01-0.90]; p = 0.040), and bowel hemorrhage (OR 7.79 [95%CI: 2.19-27.72]; p = 0.002) persisted in multivariable association with grade 3-4 WMBI. The infants with WMBI had lower mean motor, cognitive, language scores, and higher ophthalmic morbidity at 2 years of age.

Conclusions

The WMBI was most likely associated with earlier NEC onset, higher RBC transfusions, and less necrosis and greater hemorrhage lesions on intestinal pathology in preterm infants with surgical NEC.

Impact

In preterm infants with surgical NEC, brain MRI showed injury in the white matter in 52%, gray matter in 10%, and cerebellar region in 30%. Preterm infants with severe WMBI (grade 3-4) had less necrosis and greater hemorrhagic lesions on histopathology of the bowel. Preterm infants with WMBI were more likely to have a more severe postoperative course, AKI, and longer length of hospitalization. Neuroprotective strategies to prevent brain injury in preterm infants with surgical NEC are needed with the goal of improving the neurodevelopmental outcomes.

SUBMITTER: Garg PM

PROVIDER: S-EPMC10308193 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Brain injury in preterm infants with surgical necrotizing enterocolitis: clinical and bowel pathological correlates.

Garg Parvesh Mohan PM Paschal Jaslyn L JL Zhang Mengna M Pippins Melissa M Matthews Abby A Adams Kristin K Taylor Charlotte C Reddy Kartik K Inder Terrie E TE Hillegass William B WB

Pediatric research 20210608 5

<h4>Background</h4>The objective of this study was to determine the risk factors and outcomes of white matter brain injury (WMBI) on magnetic resonance imaging (MRI) at term-equivalent age in infants with surgical necrotizing enterocolitis (NEC).<h4>Methods</h4>This retrospective study compared clinical/pathological information between infants with and those without WMBI.<h4>Results</h4>Out of 69 infants with surgical NEC, 17 (24.6%) had mild WMBI, 13 (18.8%) had moderate WMBI, and six (8.7%) ha ...[more]

PMID: 34103675

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Project description:BackgroundWe sought to investigate the clinical determinants and outcomes of cholestasis in preterm infants with surgical necrotizing enterocolitis (sNEC).MethodsRetrospective comparison of clinical information in preterm infants who developed cholestasis vs those who did not.ResultsSixty-two (62/91, 68.1%) infants with NEC developed cholestasis at any time following the onset of illness. Cholestasis was seen more frequently in those who had received ionotropic support at 24 hours following sNEC diagnosis (87.1% vs 58.6%; p = 0.002), had higher mean C-reactive protein levels 2 weeks after NEC diagnosis (p = 0.009), had blood culture-positive sepsis [25 (40.3%) vs 4 (13.8%); p = 0.011], received parenteral nutrition (PN) for longer durations (108.4 ± 56.63 days vs 97.56 ± 56.05 days; p = 0.007), had higher weight-for-length z scores at 36 weeks' postmenstrual age [-1.0 (-1.73, -0.12) vs -1.32 (-1.76, -0.76); p = 0.025], had a longer length of hospital stay (153.7 ± 77.57 days vs 112.51 ± 85.22 days; p = 0.024), had intestinal failure more often (61% vs 25.0%, p = 0.003), had more surgical complications (50% vs 27.6%; p = 0.044), and had >1 complication (21% vs 3.4%; p = 0.031). Using linear regression, the number of days after surgery when feeds could be started [OR 15.4; confidence interval (CI) 3.71, 27.13; p = 0.009] and the postoperative ileus duration (OR 11.9, CI 1.1, 22.8; p = 0.03) were independently associated with direct bilirubin between 2 and 5 mg/dL (mild-moderate cholestasis) at 2 months of age. The duration of PN was independently associated with direct bilirubin >5 mg/dL (severe cholestasis) at 2 months of age in these patients.ConclusionCholestasis was seen in 68% of infants following surgical NEC. The most likely contributive factors are intestinal failure and subsequent PN dependence for longer periods. Our data suggest that identification and prevention of risk factors such as sepsis and surgical complications and early feeds following NEC surgery may improve outcomes.

Project description:ObjectiveWe sought to determine the clinical and histopathological factors linked with intestinal repair and its correlation with clinical outcomes in preterm infants following surgical necrotizing enterocolitis (NEC).MethodsA retrospective study has compared clinical and histopathological characteristics between preterm infants with histopathological reparative changes versus non-reparative changes in resected intestinal tissue following surgical treatment of NEC. Reparative changes were defined as microscopic evidence of neovascularization, increased fibroblasts or myofibroblasts, and epithelial regeneration during histopathological examination of the most affected area of resected intestinal tissue.ResultsThe infants with reparative changes (53/148) had significantly lower median birth weight (725 [650-963] vs. 920 [690-1320]; p = .018), higher likelihood of patent ductus arteriosus (38/53 [71.7%] vs. 48/95 [50.5%]; p = .012), longer TPN days (99 [56-147] vs. 76.5 [39-112.5]; p = .034), higher CRP levels (7.3 [3.2-13] vs. 2.6 [1.1-7.8]; p = .011) at NEC onset, and more short bowel syndrome (27/53 [54.0%] vs. 28/95 [32.2%]; p = .012). Those with reparative changes also received more Penrose drain therapy (21/53 [39.6%] vs. 14/95 [14.7%]; p = .011) and had a longer median time to laparotomy (108 h [28-216] vs. 24 [12-96]; p = .003). Epithelial regeneration observed in 6/53 (11.3%) infants lagged fibroblast proliferation and neovascularization changes in the submucosa/muscularis intestinal layers. On a multivariable logistic regression model which included histopathological and clinical factors, inflammation with a percentage <25% area involvement, time from NEC diagnosis to surgery, and Apgar score < 6 at 5 min were independently and significantly associated with higher odds reparative changes.ConclusionIn neonates with surgical NEC, the histopathological findings in the resected bowel are significantly associated with clinical characteristics, other histopathological findings, and outcomes. The presence of reparative changes consistent with healing is significantly associated with Apgar score, Penrose drain therapy, longer time from NEC diagnosis to surgery, and lower burden of inflammation in the resected bowel tissue in multivariable analyses. Routine histopathological grading of resected bowel and optimal use of Penrose drain therapy warrant further investigation in the care of neonates with surgical NEC.

Project description:Objective This study aimed to identify the clinical and growth parameters associated with retinopathy of prematurity (ROP) in infants with necrotizing enterocolitis (NEC) and spontaneous ileal perforation (SIP).Study design We conducted a retrospective cohort study that compared clinical data before and after NEC/SIP onset in neonates, categorizing by any ROP and severe ROP (type 1/2) status.Results The analysis included 109 infants with surgical NEC/SIP. Sixty infants (60/109, 55%) were diagnosed with any ROP, 32/109 (29.3%) infants (22% type 1 and 7.3% type 2) with severe ROP. On univariate analysis, those with severe ROP (32/109, 39.5%) were of lower median gestational age (GA, 23.8 weeks [23.4, 24.6] vs. 27.3 [26.3, 29.0], p < 0.001), lower median birth weight (625 g [512, 710] vs. 935 [700, 1,180], p < 0.001) and experienced higher exposure to clinical chorioamnionitis (22.6 vs. 2.13%, p < 0.006), and later median onset of ROP diagnosis (63.0 days [47.0, 77.2] vs. 29.0 [19.0, 41.0], p < 0.001), received Penrose drain placement more commonly (19 [59.4%] vs. 16 [34.0%], p = 0.04), retained less residual small bowel (70.0 cm [63.1, 90.8] vs. 90.8 [72.0, 101], p = 0.007) following surgery, were exposed to higher FiO2 7 days after birth (p = 0.001), received ventilation longer and exposed to higher FiO2 at 2 weeks (p < 0.05) following NEC and developed acute kidney injury (AKI) more often (25 [86.2%] vs. 20 [46.5%], p = 0.002) than those without ROP. Those with severe ROP had lower length, weight for length, and head circumference z scores. In an adjusted Firth's logistic regression, GA (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI]: [0.35, 0.76]) and diagnosis at later age (aOR = 1.08, 95% CI: [1.03, 1.13]) was shown to be significantly associated with any ROP.Conclusion Infants who develop severe ROP following surgical NEC/SIP are likely to be younger, smaller, have been exposed to more O2, develop AKI, and grow poorly compared with those did not develop severe ROP.Key points· Thirty percent of infants with NEC/SIP had severe ROP.. · Those with severe ROP had poor growth parameters before and after NEC/SIP.. · Risk factors based ROP prevention strategies are needed to have improved ophthalmic outcomes..

Project description:Background: To investigate the association between the timing of surgery from the day of NEC/SIP diagnosis and clinical outcomes in preterm infants. Study Design: A retrospective cohort study comparing clinical outcomes of infants undergoing laparotomy at three clinically relevant time points (less and more than 48 hours, 96 hours, and 168 hours [7 days]) following NEC/SIP diagnosis. Results: Infants with NEC/SIP (N = 97) receiving surgical invention >96 hours (34/97) had significantly lower gestational age (25.5 weeks [24.0; 26.9] vs 27.0 [25.0; 31.3]; p = 0.006), had lower birth weight (687 grams [600; 902] vs 940 [710; 1495]; p<0.001), had pneumoperitoneum less often on the abdominal x-ray (29.4% vs 57.1%, p = 0.017), had hemorrhagic (p = 0.04) and reparative (p = 0.003) lesions more often on intestinal histopathology, had PDA diagnosed more often (76.5% vs 50.8%, p = 0.02), required assisted ventilation more frequently (p = 0.013), and received parenteral nutrition for longer duration (112 days [76.5; 145] vs 65.0 [23.0; 112], p = 0.004) following surgery compared to the infants receiving surgical intervention before 96 hours (n = 63/97). In NEC-only sub-cohort, infants receiving laparotomy >48 hours (n = 29/75) had lower median gestational age, lower birth weight, less pneumoperitoneum, and higher acute kidney injury than those receiving surgery <48 hours. On logistic regression, the odds of death were not significantly different (OR 0.65 [0.28, 1.54], p = 0.32) for infants receiving laparotomy ≤48 hours following NEC/SIP compared to subjects undergoing surgery >48 hours. The odds of intestinal failure (>60 days of parenteral nutrition) were 4.5 times (CI 1.56, 14.3), p = 0.005) higher for those having surgery >96 hours from NEC/SIP diagnosis. Conclusion: There was no significant difference in death among infants receiving surgery within 48 hours following surgical NEC/SIP diagnosis compared to those receiving surgery at ≥ 48 hours of diagnosis. However, infants receiving surgery >96 hours were more likely to receive parenteral nutrition for longer time. A prospective study is needed to understand the continuous relationship between time to surgery and outcomes.

Dataset Information

Brain injury in preterm infants with surgical necrotizing enterocolitis: clinical and bowel pathological correlates.

Background

Methods

Results

Conclusions

Impact

Publications

Brain injury in preterm infants with surgical necrotizing enterocolitis: clinical and bowel pathological correlates.

Similar Datasets

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