Cognitive Outcomes in Children With Conditions Affecting the Small Intestine

Abstract

Objectives: The aim of the study was to assess cognitive outcomes in children with intestinal failure (IF) and children at high risk of IF with conditions affecting the small intestine requiring parenteral nutrition. Methods: EMBASE, Cochrane, Web of Science, Google Scholar, MEDLINE, and PsycINFO were searched from inception to October 2020. Studies were included constituting original data on developmental quotient (DQ), intelligence quotient (IQ) and/or severe developmental delay/disability (SDD) rates assessed with standardized tests. We used appropriate standardized tools to extract data and assess study quality. We performed random effects meta-analyses to estimate pooled means of DQ/IQ and pooled SDD rates (general population mean for DQ/IQ: 100, for percentage with SDD: 1.8%) for 4 groups: IF, surgical necrotizing enterocolitis (NEC), abdominal wall defects (AWD), and midgut malformations (MM). Associations of patient characteristics with DQ/IQ were evaluated with meta-regressions. Results: Thirty studies met the inclusion criteria. The pooled mean DQ/IQ for IF, NEC, AWD, and MM were 86.8, 83.3, 96.6, and 99.5, respectively. The pooled SDD rates for IF, NEC, AWD and MM were 28.6%, 32.8%, 8.5%, and 3.7%, respectively. Meta-regressions indicated that lower gestational age, longer hospital stay, and higher number of surgeries but not parenteral nutrition duration, were associated with lower DQ/IQ. Conclusions: Adverse developmental outcomes are common in children with IF and NEC, and to a much lesser extent in children with AWD and MM. It is important to monitor cognitive development in children with conditions affecting the small intestine and to explore avenues for prevention and remediation.

The role of neutrophil extracellular traps in necrotizing enterocolitis

“…Notably, NEC is not solely a disease of the abdomen, rather it is a multisystemic disease that can also affect other organ systems ( 17 – 19 ). Systemic reviews have demonstrated that NEC is an independent risk factor for neurocognitive developmental delay and poor neurocognitive outcomes ( 20 , 21 ). Moreover, studies suggest that common morbidities of the preterm infant such as bronchopulmonary dysplasia (BPD) and brain damage are affected by the development of NEC necrotizing enterocolitis, through interactions known as the “Gut-Lung-Axis” and “Gut-Brain-Axis”, respectively ( 18 , 19 ).…”

Children with Intestinal Failure are at Risk for Psychopathology and Trauma

“…As the IF population grows older, new challenges concerning long‐term neurodevelopmental outcomes and psychosocial functioning have gained attention. Low gestational age, long hospitalization, and multiple surgical procedures are associated with impaired neurodevelopment in IF (4). There are few published studies concerning the psychological impact of home PN on children with IF and their families (5–9).…”