Neurodevelopment of Extremely Preterm Infants who had Necrotizing Enterocolitis with or without Late Bacteremia

Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
The Journal of pediatrics (Impact Factor: 3.79). 11/2010; 157(5):751-6.e1. DOI: 10.1016/j.jpeds.2010.05.042
Source: PubMed


To evaluate neurodevelopment after necrotizing enterocolitis (NEC) and late bacteremia, alone and together.
Sample included 1155 infants born at 23 to 27 weeks' gestation. NEC was classified by the modified Bell's staging criteria and grouped as medical NEC or surgical NEC. Late bacteremia was defined as a positive blood culture result after the first postnatal week. Neurodevelopment was assessed at 24 months corrected age. Multivariable models estimated the risk of developmental dysfunction and microcephaly associated with medical or surgical NEC with and without late bacteremia.
Children who had surgical NEC unaccompanied by late bacteremia were at increased risk of psychomotor developmental indexes <70 (OR = 2.7 [1.2, 6.4]), and children who had both surgical NEC and late bacteremia were at increased risk of diparetic cerebral palsy (OR = 8.4 [1.9, 39]) and microcephaly (OR = 9.3 [2.2, 40]). In contrast, children who had medical NEC with or without late bacteremia were not at increased risk of any developmental dysfunction.
The risk of neurodevelopmental dysfunction and microcephaly is increased in children who had surgical NEC, especially if they also had late bacteremia. These observations support the hypothesis that bowel injury might initiate systemic inflammation potentially affecting the developing brain.

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Available from: Camilia R Martin, Apr 12, 2014
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    • "There is strong evidence that infants with NEC are at risk of poorer neuro-developmental outcomes compared to infants without NEC. Similarly, the risk of worse neuro-developmental outcome increases with the severity of disease (Hintz et al., 2005; Martin et al., 2010; Rees et al., 2007; Schulzke et al., 2007; Stanford et al., 2002). "
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    • "<34 weeks Intention-to-treat plus positive culture from blood, endotracheal tube, urine, skin lesion, or CSF (plus suggestive CSF fi ndings) Cases of meningoencephalitis excluded from analysis because of small numbers, meningoencephalitis was not signifi cantly associated with adverse outcomes Recurrent postnatal infections are associated with increased risk of progressive white matter injury Shah et al (2008) 44 192 <30 weeks Positive blood culture plus abnormal immature neutrophil to total neutrophil ratio, C-reactive protein, or platelet count plus ≥5 days of antibiotics; meningitis, CSF contains >20 cells/µL plus therapeutic course of antibiotics Three cases of culture-negative meningitis; two in proven sepsis group, one in clinical sepsis group Postnatal infection or NEC, or both, associated with white matter injury increased risk of motor impairment at 2 years of age Chau et al (2009) 49 96 24–32 weeks Any positive culture from blood, CSF, urine; in tracheal aspirate if associated with >4 leucocytes and clinical pneumonia No case of meningitis mentioned Postnatal infection, but not histological chorioamnionitis is associated with white matter injury Bassler et al (2009) 33 944 Birthweight 500–999 g Sepsis, positive blood culture; meningitis, positive CSF culture, no further information give 22 cases of meningitis with or without sepsis, showed strongest association with adverse outcome Any postnatal infection or NEC increased the risk of late death or survival with neurosensory impairment Martin et al (2010) 41 1155 23–27 weeks Positive blood culture (taken weekly as routine part of ELGAN study) Meningitis not mentioned Increased risk of impaired neurodevelopment at 24 months of age in infants with surgical NEC, especially when accompanied by sepsis Helderman et al (2010) "
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    • "Additional support for this hypothesis comes from magnetic resonance imaging studies demonstrating white-matter injury associated with bacterial infections and NEC in premature infants (Shah et al., 2008). In accordance , the recent study by Martin, reports a higher risk of neurodevelopmental dysfunction and microcephaly in NEC infants with late bacteremia (Martin et al., 2010). Of note, postnatal infections result in increased white-matter injury in premature infants (Chau et al., 2009). "
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