TY - JOUR
T1 - Surgical necrotizing enterocolitis but not spontaneous intestinal perforation is associated with adverse neurological outcome at school age
AU - The German Neonatal Network (GNN)
AU - Humberg, Alexander
AU - Spiegler, Juliane
AU - Fortmann, Mats Ingmar
AU - Zemlin, Michael
AU - Marissen, Janina
AU - Swoboda, Isabelle
AU - Rausch, Tanja K.
AU - Herting, Egbert
AU - Göpel, Wolfgang
AU - Härtel, Christoph
AU - Wieg, Christian
AU - Kribs, Angela
AU - von der Wense, Axel
AU - Weller, Ursula
AU - Höhn, Thomas
AU - Olbertz, Dirk M.
AU - Felderhoff-Müser, Ursula
AU - Rossi, Rainer
AU - Teig, Norbert
AU - Heitmann, Friedhelm
AU - Schmidtke, Susanne
AU - Bohnhorst, Bettina
AU - Vochem, Matthias
AU - Michel, Holger
AU - Möller, Jens
AU - Eichhorn, Joachim G.
AU - Wintgens, Jürgen
AU - Böttger, Ralf
AU - Hubert, Mechthild
AU - Dördelmann, Michael
AU - Hillebrand, Georg
AU - Roll, Claudia
AU - Jensen, Reinhard
AU - Rüdiger, Mario
AU - Sandkötter, Julia
AU - Schäfer, Stefan
AU - Schaible, Thomas
AU - Franz, Axel
AU - Aydin, Malik
AU - Ehlers, Silke
AU - Werner, Claudius
AU - Orlikowsky, Thorsten
AU - Gerleve, Hubert
AU - Schneider, Katja
AU - Werner, Claudius
AU - Böckenholt, Kai
AU - Linnemann, Knud
AU - Müller, Dirk
AU - Gebauer, Corinna
AU - Guthmann, Florian
N1 - Funding Information:
ethics. Approval by the local ethic committee for research in human subjects of the University of Lübeck (file number 08–022) and by the local ethic committees of all participating centres has been given. Written informed parental consent was given for the research and publication of the results of each infant included in the study. The German Neonatal Network is funded by the German Ministry for Education and Research (BMBF-grant-No: 01ER0805 and 01ER1501).
Funding Information:
The authors would like to thank all nurses, doctors and participating NICUs for their support and especially all participating infants and their parents. The German Neonatal Network is funded by the German Ministry for Education and Research (BMBF-grant-No: 01ER0805 and 01ER1501). The sponsor had no role in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication.
Publisher Copyright:
© 2020, The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/2/11
Y1 - 2020/2/11
N2 - Gastrointestinal complications during the neonatal period, i.e. necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP), are associated with adverse short-term outcome in very-low-birthweight infants (VLBWI, <1500 g birth weight). However, little is known about the neurological outcome of survivors at school age. We analysed data of 2241 infants followed-up at the age of 6 years. To determine the effect of NEC and SIP on cognitive outcome in consideration of other important confounding factors, we used multivariable logistic regression models. In addition, infants with surgical diagnosis of NEC (n = 43) or SIP (n = 41) were compared to NEC (n = 43) or SIP (n = 41) negative controls using Mahalanobis distance matching. Infants with a history for NEC had a three times increased risk (RR 3.0 [1.8–4.2], p < 0.001) to develop IQ scores <85 while history of surgical SIP did not increase the relative risk for lower IQs at school age (RR 1.0 [0.4–2.1], p = 1.000). In a matched-cohort analysis, we confirmed that infants with surgical NEC had lower mean IQ results than unaffected controls (±SD) (85±17 vs. 94±14, p = 0.023) while no differences were found for history of SIP. Our results reflect that the different aetiology and inflammatory extent of NEC and SIP may lead to disparate neurodevelopment trajectories. Hence, our data suggest a potential role of early gut-brain axis distortion in infants with NEC which needs to be further explored.
AB - Gastrointestinal complications during the neonatal period, i.e. necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP), are associated with adverse short-term outcome in very-low-birthweight infants (VLBWI, <1500 g birth weight). However, little is known about the neurological outcome of survivors at school age. We analysed data of 2241 infants followed-up at the age of 6 years. To determine the effect of NEC and SIP on cognitive outcome in consideration of other important confounding factors, we used multivariable logistic regression models. In addition, infants with surgical diagnosis of NEC (n = 43) or SIP (n = 41) were compared to NEC (n = 43) or SIP (n = 41) negative controls using Mahalanobis distance matching. Infants with a history for NEC had a three times increased risk (RR 3.0 [1.8–4.2], p < 0.001) to develop IQ scores <85 while history of surgical SIP did not increase the relative risk for lower IQs at school age (RR 1.0 [0.4–2.1], p = 1.000). In a matched-cohort analysis, we confirmed that infants with surgical NEC had lower mean IQ results than unaffected controls (±SD) (85±17 vs. 94±14, p = 0.023) while no differences were found for history of SIP. Our results reflect that the different aetiology and inflammatory extent of NEC and SIP may lead to disparate neurodevelopment trajectories. Hence, our data suggest a potential role of early gut-brain axis distortion in infants with NEC which needs to be further explored.
UR - http://www.scopus.com/inward/record.url?scp=85079334134&partnerID=8YFLogxK
U2 - 10.1038/s41598-020-58761-6
DO - 10.1038/s41598-020-58761-6
M3 - Journal articles
C2 - 32047169
AN - SCOPUS:85079334134
SN - 2045-2322
VL - 10
SP - 2373
JO - Scientific Reports
JF - Scientific Reports
IS - 1
M1 - 2373
ER -