title: Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis.
abstract: OBJECTIVE
  Necrotizing enterocolitis (NEC) is a significant complication for the premature infant. However, subsequent neurodevelopmental and growth outcomes of extremely low birth weight (ELBW) infants with NEC have not been well described. We hypothesized that ELBW infants with surgically managed (SurgNEC) are at greater risk for poor neurodevelopmental and growth outcomes than infants with medically managed NEC (MedNEC) compared with infants without a history of NEC (NoNEC). The objective of this study was to compare growth, neurologic, and cognitive outcomes among ELBW survivors of SurgNEC and MedNEC with NoNEC at 18 to 22 months' corrected age.
  
  
  METHODS
  Multicenter, retrospective analysis was conducted of infants who were born between January 1, 1995, and December 31, 1998, and had a birth weight <1000 g in the National Institute of Child Health and Human Development Neonatal Research Network Registry. Neurodevelopment and growth were assessed at 18 to 22 months' postmenstrual age. chi2, t test, and logistic regression analyses were used.
  
  
  RESULTS
  A total of 2948 infants were evaluated at 18 to 22 months, 124 of whom were SurgNEC and 121 of whom were MedNEC. Compared with NoNEC, both SurgNEC and MedNEC infants were of lower birth weight and had a greater incidence of late sepsis; SurgNEC but not MedNEC infants were more likely to have received a diagnosis of cystic periventricular leukomalacia and bronchopulmonary dysplasia and been treated with postnatal steroids. Weight, length, and head circumference <10 percentile at 18 to 22 months were significantly more likely among SurgNEC but not MedNEC compared with NoNEC infants. After correction for anthropometric measures at birth and adjusted age at follow-up, all growth parameters at 18 to 22 months for SurgNEC but not MedNEC infants were significantly less than for NoNEC infants. SurgNEC but not MedNEC was a significant independent risk factor for Mental Developmental Index <70 (odds ratio [OR]: 1.61; 95% confidence interval [CI]: 1.05-2.50), Psychomotor Developmental Index <70 (OR: 1.95; 95% CI: 1.25-3.04), and neurodevelopmental impairment (OR: 1.78; 95% CI: 1.17-2.73) compared with NoNEC.
  
  
  CONCLUSIONS
  Among ELBW infants, SurgNEC is associated with significant growth delay and adverse neurodevelopmental outcomes at 18 to 22 months' corrected age compared with NoNEC. MedNEC does not seem to confer additional risk. SurgNEC is likely to be associated with greater severity of disease.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, USA. srhintz@stanford.edu
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Kendrick
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.forename: Avroy A
authors.initials: AA
authors.lastname: Fanaroff
authors.forename: Edward F
authors.initials: EF
authors.lastname: Donovan
authors.forename: W Kenneth
authors.initials: WK
authors.lastname: Poole
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.forename: Linda
authors.initials: L
authors.lastname: Wright
authors.forename: Rosemary
authors.initials: R
authors.lastname: Higgins
mesh_terms: D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology*; D002657:Child Development; D002658:Developmental Disabilities; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006128:Growth; D006311:Hearing Disorders / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development / Q000523:psychology; D016015:Logistic Models; D008297:Male; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*