Surgical Necrotizing Enterocolitis versus Spontaneous Intestinal Perforation in White Matter Injury on Brain Magnetic Resonance Imaging.
White matter injury (WMI) is the most common form of brain injury in preterm infants. It could be induced by a systemic inflammatory response in preterm infants.



We hypothesized that surgical necrotizing enterocolitis (surgNEC) results in more severe WMI than spontaneous intestinal perforation (SIP) on brain magnetic resonance imaging (MRI) at term-equivalent age (TEA).



The medical records of 33 preterm infants born at less than 32 weeks of gestation who underwent surgery due to either NEC or SIP were reviewed retrospectively. White matter abnormality (WMA) on brain MRI was scored according to the diagnosis of surgNEC or SIP.



Nine patients were diagnosed with SIP and 24 with surgNEC. The median (range) gestational age of the SIP and surgNEC groups was 26+6 (23+3-27+6) and 25+5 weeks (23+3-31+2), respectively (p = 0.454). There were no differences in 1- and 5-min Apgar scores, mode of delivery, use of antenatal steroids, histologic chorioamnionitis, or incidence of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) between the two groups. Males were more prevalent in the surgNEC group (75.0 vs. 33.3%, p = 0.044), and the incidence of sepsis was higher in the surgNEC group than in the SIP group (75.0 vs. 33.3%, p = 0.044). Multivariate regression showed that the difference in WMA scores between the two groups remained significant (estimated difference = 2.418; 95% CI 0.107-4.729).



In preterm infants at less than 32 weeks of gestation, those with surgNEC showed more severe WMI than infants with SIP on brain MRI at TEA.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Seung Han
SH
Shin
Ee-Kyung
EK
Kim
Hani
H
Yoo
Young Hun
YH
Choi
Saeyun
S
Kim
Byoung Kook
BK
Lee
Young Hwa
YH
Jung
Hyun-Young
HY
Kim
Han-Suk
HS
Kim
Jung-Hwan
JH
Choi
D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000150:complications* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D056910:Republic of Korea; D012189:Retrospective Studies; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology*