title: Neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical necrotizing enterocolitis.
abstract: OBJECTIVE
  To determine if extremely low birth weight infants with surgical necrotizing enterocolitis have a higher risk of death or neurodevelopmental impairment and neurodevelopmental impairment among survivors (secondary outcome) at 18-22 months corrected age compared with infants with spontaneous intestinal perforation and infants without necrotizing enterocolitis or spontaneous intestinal perforation.
  
  
  METHODS
  Retrospective analysis of the Neonatal Research Network very low birth weight registry, evaluating extremely low birth weight infants born between 2000 and 2005. The study infants were designated into three groups: (1) spontaneous intestinal perforation without necrotizing enterocolitis; (2) surgical necrotizing enterocolitis (Bell's stage III); and (3) neither spontaneous intestinal perforation nor necrotizing enterocolitis. Multivariate logistic regression analysis was performed to evaluate the association between the clinical group and death or neurodevelopmental impairment, controlling for multiple confounding factors including center.
  
  
  RESULTS
  Infants with surgical necrotizing enterocolitis had the highest rate of death before hospital discharge (53.5%) and death or neurodevelopmental impairment (82.3%) compared with infants in the spontaneous intestinal perforation group (39.1 and 79.3%) and no necrotizing enterocolitis/no spontaneous intestinal perforation group (22.1 and 53.3%; P<0.001). Similar results were observed for neurodevelopmental impairment among survivors. On logistic regression analysis, both spontaneous intestinal perforation and surgical necrotizing enterocolitis were associated with increased risk of death or neurodevelopmental impairment (adjusted odds ratio 2.21, 95% confidence interval (CI): 1.5, 3.2 and adjusted OR 2.11, 95% CI: 1.5, 2.9, respectively) and neurodevelopmental impairment among survivors (adjusted OR 2.17, 95% CI: 1.4, 3.2 and adjusted OR 1.70, 95% CI: 1.2, 2.4, respectively).
  
  
  CONCLUSIONS
  Spontaneous intestinal perforation and surgical necrotizing enterocolitis are associated with a similar increase in the risk of death or neurodevelopmental impairment and neurodevelopmental impairment among extremely low birth weight survivors at 18-22 months corrected age.
authors.affiliation: Department of Pediatrics, Women & Infants Hospital, Providence, RI, USA.
authors.forename: R
authors.initials: R
authors.lastname: Wadhawan
authors.affiliation: Department of Pediatrics, Women & Infants Hospital, Providence, RI, USA.
authors.forename: W
authors.initials: W
authors.lastname: Oh
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Hintz
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Blakely
authors.affiliation: Statistics and Epidemiology Unit, RTI International, Rockville, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: Bell
authors.affiliation: Statistics and Epidemiology Unit, RTI International, Research Triangle Park, Durham, NC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Saha
authors.affiliation: Department of Pediatrics, Women & Infants Hospital, Providence, RI, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Laptook
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, MI, USA.
authors.forename: S
authors.initials: S
authors.lastname: Shankaran
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Stoll
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Walsh
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D002657:Child Development; D002658:Developmental Disabilities / Q000209:etiology*; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000150:complications*; D016015:Logistic Models; D011247:Pregnancy; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D013256:Steroids