The Permanente Medical Group, Kaiser Oakland Medical Center, Oakland, CA.
Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
J Pediatr. 2021 Mar;230:76-83.e5. doi: 10.1016/j.jpeds.2020.11.026. Epub 2020 Nov 24.
To determine if preterm infants with surgical necrotizing enterocolitis (sNEC) or spontaneous intestinal perforation (SIP) with short bowel syndrome (SBS) have worse neurodevelopmental and growth outcomes than those with sNEC/SIP without SBS, and those with no necrotizing enterocolitis, SIP, or SBS.
We undertook a retrospective analysis of prospectively collected data from infants born between 22 and 26 weeks of gestation in the National Institute of Child Health and Human Development Neonatal Research Network centers from January 1, 2008, to December 31, 2016. Survivors were assessed at 18-26 months corrected age by standardized neurologic examination and Bayley Scales of Infant and Toddler Development, Third Edition. The primary outcome was moderate-severe neurodevelopmental impairment. Growth was assessed using World Health Organization z-score standards. Adjusted relative risks were estimated using modified Poisson regression models.
Mortality was 32%, 45%, and 21% in the 3 groups, respectively. Eighty-nine percent of survivors were seen at 18-26 months corrected age. Moderate-severe neurodevelopmental impairment was present in 77% of children with SBS compared with 62% with sNEC/SIP without SBS (adjusted relative risk, 1.22; 95% CI, 1.02-1.45; P = .03) and 44% with no necrotizing enterocolitis, SIP, or SBS (adjusted relative risk, 1.60; 95% CI, 1.37-1.88; P < .001). Children with SBS had lowcognitive, language, and motor scores than children with sNEC/SIP without SBS. At follow-up, length and head circumference z-scores remained more than 1 SD below the mean for children with SBS.
Preterm infants with sNEC/SIP and SBS had increased risk of adverse neurodevelopmental outcomes at 18-26 months corrected age and impaired growth compared with peers with sNEC/SIP without SBS or without any of these conditions.
确定患有外科坏死性小肠结肠炎（sNEC）或自发性肠穿孔（SIP）伴短肠综合征（SBS）的早产儿与无 SBS 的 sNEC/SIP 早产儿以及无坏死性小肠结肠炎、SIP 或 SBS 的早产儿相比，神经发育和生长结局是否更差。
我们对 2008 年 1 月 1 日至 2016 年 12 月 31 日期间在国家儿童健康与人类发展研究所新生儿研究网络中心出生、胎龄为 22 至 26 周的婴儿前瞻性收集的数据进行了回顾性分析。幸存者在 18-26 个月的校正年龄时通过标准化神经检查和贝利婴幼儿发育量表第三版进行评估。主要结局是中重度神经发育障碍。使用世界卫生组织 z 分数标准评估生长。使用修正泊松回归模型估计调整后的相对风险。
三组的死亡率分别为 32%、45%和 21%。89%的幸存者在 18-26 个月的校正年龄时接受了检查。与无 SBS 的 sNEC/SIP 早产儿（调整后相对风险，1.22；95%置信区间，1.02-1.45；P=0.03）和无坏死性小肠结肠炎、SIP 或 SBS 的早产儿（调整后相对风险，1.60；95%置信区间，1.37-1.88；P<0.001）相比，SBS 组中 77%的儿童存在中重度神经发育障碍。与无 SBS 的 sNEC/SIP 早产儿相比，SBS 组儿童的认知、语言和运动评分较低。在随访时，SBS 组儿童的身高和头围 z 分数仍低于平均值 1 个标准差以上。
患有 sNEC/SIP 和 SBS 的早产儿在 18-26 个月的校正年龄时神经发育不良的风险增加，与无 SBS 的 sNEC/SIP 早产儿或无任何这些情况的早产儿相比，生长受损。
