Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants

doi:10.1097/SLA.0000000000006378

Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants

Pediatrics

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure. Summary Background Data: Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited. Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <-2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables. Results: Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P=0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2). Conclusions: This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months.

Original language	English
Pages (from-to)	432-443
Number of pages	12
Journal	Annals of Surgery
Volume	280
Issue number	3
DOIs	https://doi.org/10.1097/SLA.0000000000006378
State	Published - Sep 1 2024

Bibliographical note

Publisher Copyright:
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Funding

This study was supported by the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (U10 HD27871, U10 HD53119, UG1 HD21364, UG1 HD21373, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880, UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68270, UG1 HD68278, UG1 HD68263, UG1 HD68284, UG1 HD87226, UG1 HD87229) and the National Center for Advancing Translational Sciences (NCATS) (UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR442, UL1 TR454, UL1 TR1117) provided grant support through cooperative agreements for the Neonatal Research Network’s Necrotizing Enterocolitis Surgery Trial (NEST). Additionally, the National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provided grant support for Speer (1K08DK131326), and the National Institutes of Health and the National Heart, Lung, and Blood Institute (NHLBI) provided grant support for Ohls (1R01HL166254). This study was supported by the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (U10 HD27871, U10 HD53119, UG1 HD21364, UG1 HD21373, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880, UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68270, UG1 HD68278, UG1 HD68263, UG1 HD68284, UG1 HD87226, UG1 HD87229) and the National Center for Advancing Translational Sciences (NCATS) (UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR442, UL1 TR454, UL1 TR1117) provided grant support through cooperative agreements for the Neonatal Research Network's Necrotizing Enterocolitis Surgery Trial (NEST). Additionally, the National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provided grant support for Speer (1K08DK131326), and the National Institutes of Health and the National Heart, Lung, and Blood Institute (NHLBI) provided grant support for Ohls (1R01HL166254).

Funders	Funder number
Neonatal Research Network’s Necrotizing Enterocolitis Surgery Trial
National Institutes of Health (NIH)
European NEST
Neonatal Research Network's Necrotizing Enterocolitis Surgery Trial
Eunice Kennedy Shriver National Institute of Child Health and Human Development	UG1 HD27851, UG1 HD34216, UG1 HD68270, UG1 HD27853, UG1 HD68284, UG1 HD53109, UG1 HD27856, UG1 HD27904, UG1 HD53089, UG1 HD36790, UG1 HD40689, U10 HD53119, UG1 HD87229, U10 HD27871, UG1 HD68263, UG1 HD21385, UG1 HD68244, UG1 HD21364, UG1 HD68278, UG1 HD21373, UG1 HD40492, UG1 HD27880, UG1 HD87226
National Center for Advancing Translational Sciences (NCATS)	UL1 TR442, UL1 TR454, UL1 TR1117
National Heart, Lung, and Blood Institute (NHLBI)	1R01HL166254
National Institute of Diabetes and Digestive and Kidney Diseases	1K08DK131326

Keywords

Growth failure
infant
laparotomy
necrotizing enterocolitis
peritoneal drain
spontaneous intestinal perforation

ASJC Scopus subject areas

Surgery

Access to Document

10.1097/SLA.0000000000006378

Cite this

@article{c9fd0a6266b34123ac473791f8ea8022,

title = "Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants",

abstract = "Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure. Summary Background Data: Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited. Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <-2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables. Results: Among 217 survivors, 207 infants (95\%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48\%) of NEC infants versus 65/157 (42\%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P=0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95\% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2). Conclusions: This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months.",

keywords = "Growth failure, infant, laparotomy, necrotizing enterocolitis, peritoneal drain, spontaneous intestinal perforation",

author = "Speer, \{Allison L.\} and Lally, \{Kevin P.\} and Claudia Pedroza and Yuxin Zhang and Poindexter, \{Brenda B.\} and Chwals, \{Walter J.\} and Hintz, \{Susan R.\} and Besner, \{Gail E.\} and Stevenson, \{David K.\} and Ohls, \{Robin K.\} and Truog, \{William E.\} and Stoll, \{Barbara J.\} and Rysavy, \{Matthew A.\} and Abhik Das and Tyson, \{Jon E.\} and Blakely, \{Martin L.\} and Polin, \{Richard A.\} and Caplan, \{Michael S.\} and S{\'a}nchez, \{Pablo J.\} and Nelin, \{Leif D.\} and Moss, \{R. Lawrence\} and Maitre, \{Nathalie L.\} and Jadcherla, \{Sudarshan R.\} and Patricia Luzader and Fortney, \{Christine A.\} and Julie Gutentag and Yeates, \{Keith O.\} and Timan, \{Christopher J.\} and Small, \{Kristi L.\} and Sullivan, \{Rox Ann\} and Jacqueline McCool and Melanie Stein and Erin Fearns and Quan, \{Lorraine Kelly\} and Thakkar, \{Rajan K.\} and Hague, \{Cole D.\} and Stephanie Burkhardt and Jessica Purnell and Nelin, \{Mary Ann\} and Helen Carey and Lindsay Pietruszewski and Laptook, \{Abbot R.\} and Martin Keszler and Kurkchubasche, \{Arlet G.\} and Vohr, \{Betty R.\} and McGowan, \{Elisabeth C.\} and Hensman, \{Angelita M.\} and Barbara Alksninis and Kristin Basso and Goldstein, \{Ricki F.\}",

year = "2024",

month = sep,

day = "1",

doi = "10.1097/SLA.0000000000006378",

language = "English",

volume = "280",

pages = "432--443",

number = "3",

}

TY - JOUR

T1 - Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants

AU - Speer, Allison L.

AU - Lally, Kevin P.

AU - Pedroza, Claudia

AU - Zhang, Yuxin

AU - Poindexter, Brenda B.

AU - Chwals, Walter J.

AU - Hintz, Susan R.

AU - Besner, Gail E.

AU - Stevenson, David K.

AU - Ohls, Robin K.

AU - Truog, William E.

AU - Stoll, Barbara J.

AU - Rysavy, Matthew A.

AU - Das, Abhik

AU - Tyson, Jon E.

AU - Blakely, Martin L.

AU - Polin, Richard A.

AU - Caplan, Michael S.

AU - Sánchez, Pablo J.

AU - Nelin, Leif D.

AU - Moss, R. Lawrence

AU - Maitre, Nathalie L.

AU - Jadcherla, Sudarshan R.

AU - Luzader, Patricia

AU - Fortney, Christine A.

AU - Gutentag, Julie

AU - Yeates, Keith O.

AU - Timan, Christopher J.

AU - Small, Kristi L.

AU - Sullivan, Rox Ann

AU - McCool, Jacqueline

AU - Stein, Melanie

AU - Fearns, Erin

AU - Quan, Lorraine Kelly

AU - Thakkar, Rajan K.

AU - Hague, Cole D.

AU - Burkhardt, Stephanie

AU - Purnell, Jessica

AU - Nelin, Mary Ann

AU - Carey, Helen

AU - Pietruszewski, Lindsay

AU - Laptook, Abbot R.

AU - Keszler, Martin

AU - Kurkchubasche, Arlet G.

AU - Vohr, Betty R.

AU - McGowan, Elisabeth C.

AU - Hensman, Angelita M.

AU - Alksninis, Barbara

AU - Basso, Kristin

AU - Goldstein, Ricki F.

PY - 2024/9/1

Y1 - 2024/9/1

N2 - Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure. Summary Background Data: Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited. Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <-2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables. Results: Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P=0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2). Conclusions: This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months.

AB - Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure. Summary Background Data: Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited. Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <-2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables. Results: Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P=0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2). Conclusions: This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months.

KW - Growth failure

KW - infant

KW - laparotomy

KW - necrotizing enterocolitis

KW - peritoneal drain

KW - spontaneous intestinal perforation

UR - https://www.scopus.com/pages/publications/85201103915

UR - https://www.scopus.com/pages/publications/85201103915#tab=citedBy

U2 - 10.1097/SLA.0000000000006378

DO - 10.1097/SLA.0000000000006378

M3 - Article

C2 - 39264354

AN - SCOPUS:85201103915

SN - 0003-4932

VL - 280

SP - 432

EP - 443

JO - Annals of Surgery

JF - Annals of Surgery

IS - 3

ER -

Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants

Abstract

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Funding

Keywords

ASJC Scopus subject areas

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