Neurodevelopmental impairment in necrotising enterocolitis survivors: systematic review and meta-analysis

Abstract

AimTo determine (1) the incidence of neurodevelopmental impairment (NDI) in necrotising enterocolitis (NEC), (2) the impact of NEC severity on NDI in these babies and (3) the cerebral lesions found in babies with NEC.MethodsSystematic review: three independent investigators searched for studies reporting infants with NDI and a history of NEC (PubMed, Medline, Cochrane Collaboration, Scopus). Meta-analysis: using RevMan V.5.3, we compared NDI incidence and type of cerebral lesions between NEC infants versus preterm infants and infants with medical vs surgical NEC.ResultsOf 10 674 abstracts screened, 203 full-text articles were examined. In 31 studies (n=2403 infants with NEC), NDI incidence was 40% (IQR 28%–64%) and was higher in infants with surgically treated NEC (43%) compared with medically managed NEC (27%, p<0.00001). The most common NDI in NEC was cerebral palsy (18%). Cerebral lesions: intraventricular haemorrhage (IVH) was more common in NEC babies (26%) compared with preterm infants (18%; p<0.0001). There was no difference in IVH incidence between infants with surgical NEC (25%) and those treated medically (20%; p=0.4). The incidence of periventricular leukomalacia (PVL) was significantly increased in infants with NEC (11%) compared with preterm infants (5%; p<0.00001).ConclusionsThis study shows that a large proportion of NEC survivors has NDI. NEC babies are at higher risk of developing IVH and/or PVL than babies with prematurity alone. The degree of NDI seems to correlate to the severity of gut damage, with a worse status in infants with surgical NEC compared with those with medical NEC.Trial registration numberCRD42019120522.

Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis

“…While many of these infants met the classic definitions of "extrauterine growth failure" or "postnatal growth failure" (weight < 10th percentile at discharge), experts have recently suggested that other growth metrics are more important for predicting neurodevelopmental outcomes [12]. Postnatal head-sparing growth may be critical to optimize neurodevelopment, and this is important as infants with NEC are at risk for neurodevelopmental impairment [13][14][15][16]. These results are consistent with previous studies which demonstrated that preterm infants with surgical NEC have growth failure at 18-24 months [17][18][19].…”

Necrotising enterocolitis–A 15‐year outcome report from a UK specialist centre

“…With ‘improving’ survival now achieved by surgery in the sickest NEC babies, key findings of the ORACLE study 22 and Matei et al's 23 recent publication are worthy of mention in closing. These reports clearly show the long‐term consequences of NEC on gut function, motor, sensory, and neurodevelopmental/cognitive outcome(s) highlighting the significant morbidity on patient quality of life.…”

Methodological concerns in the exclusive human milk study

“…The authors also adjusted for necrotizing enterocolitis (NEC). However, NEC partially mediates the association between the EHM and PVL [4,5]. Controlling NEC would be inappropriate as it would partially close the indirect causal path, thereby attenuating the observed association between EHM and IVH or PVL (overadjustment bias) [2,3].…”