Risk Factors for Adverse Neurodevelopment Outcomes in Neonates with Necrotizing Enterocolitis

Abstract

Background Neonatal necrotizing enterocolitis (NEC) adversely affects the long-term neurodevelopmental outcomes of preterm infants. However, few studies concerning the risk factors for neurodevelopmental outcomes in preterm infants with NEC have been conducted. Objective To investigate the risk factors for adverse neurodevelopmental outcomes of NEC in preterm infants. Methods Preterm infants diagnosed with stageⅡ toⅢ NEC in Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University from January 2019 to June 2020 were included. General conditions and neonatal complications of the infants, as well as pregnancy-related complications of the mothers were obtained. All infants were followed up to a corrected age of 12 months, at which the neurodevelopmental outcome was evaluated by the Bayley Scales of Infant Development Ⅲ (BSID-Ⅲ) , and in accordance with the evaluation results, the infants were divided into a normal group and an adverse neurodevelopment outcome group. Multivariate Logistic regression analysis was performed to investigate the risk factors for adverse neurodevelopmental outcomes. Results Of the 236 infants included, 23 died, and 13 were lost to follow up, the other 200 cases who completed the follow-up were finally included for analysis, including 21 (10.5%) with neurodevelopmental disorders (adverse neurodevelopmental outcome group) , and 179 (89.5%) with normal neurodevelopmental outcome (normal group) . Compared with infants with normal neurodevelopmental outcome, those with neurodevelopmental disorders had lower mean birth weight, and higher incidence of sepsis, intestinal perforation, and short bowel syndrome (P<0.05) . Univariate analysis revealed that, compared to infants with normal neurodevelopmental outcome, those with neurodevelopmental disorders had lower mean birth weight, and higher incidence of sepsis, bowel perforation and short bowel syndrome (P<0.05) . Multivariate Logistic regression analysis indicated that birth weight <1 000 g〔OR=4.603, 95%CI (1.220, 17.365) , P=0.024〕, sepsis〔OR=4.401, 95%CI (1.191, 16.262) , P=0.026〕and bowel perforation〔OR=5.239, 95%CI (1.522, 18.029) , P=0.009〕were independently associated with increased risk factor of adverse neurodevelopmental outcomes. Conclusion Birth weight less than 1 000 g, sepsis and bowel perforation may be risk factors for adverse neurodevelopmental outcomes in preterm infants with NEC, which should be significantly valued by newborn pediatricians for the prevention or early identification of NEC, thereby reducing the rate of NEC-caused disabilities.

Keywords

• enterocolitis, necrotizing|infant, newborn, diseases|neurodevelopmental disorders|risk factors