Department of Pediatrics/Neonatology, Wake Forest University, Winston Salem, NC, USA.
Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
J Neonatal Perinatal Med. 2024;17(5):705-716. doi: 10.3233/NPM-240022.
The preterm infants are at risk of cerebellar injury and the risk factors for necrotizing enterocolitis (NEC) associated cerebellar injury are not fully understood.
Determine the risk factors of cerebellar injury in infants with surgical necrotizing enterocolitis (NEC).
Retrospective study compared clinical/pathological information between surgical NEC infants with and those without cerebellar injury detected on brain MRI obtained at term equivalent age. Cerebellar Injury patterns that we identified on MRI brain were cerebellar hemorrhage, siderosis and/or cerebellar volume loss.
Cerebellar injury (21/65, 32.3%) in preterm infants with NEC was associated with patent ductus arteriosus (PDA) (18/21(85.7%) vs. 25/44(56.8%); p = 0.021), blood culture positive sepsis (13/21 (61.9%) vs. 11/44 (25%); p = 0.004) following NEC, predominantly grew gram positive bacteria (9/21(42.9%) vs. 4/44(9.1%); p = 0.001), greater red cell transfusion, higher rates of cholestasis following NEC and differences in intestinal histopathology (more hemorrhagic and reparative lesions) on univariate analysis. Those with cerebellar injury had higher grade white matter injury (14/21 (66.7%) vs. 4/44(9.1%) p = 0.0005) and higher-grade ROP (70.6% vs. 38.5%; p = 0.027) than those without cerebellar injury.On multilogistic regression, the positive blood culture sepsis (OR 3.9, CI 1.1-13.7, p = 0.03), PDA (OR 4.5, CI 1.0-19.9, p = 0.04) and severe intestinal pathological hemorrhage (grade 3-4) (OR 16.9, CI 2.1-135.5, p = 0.007) were independently associated with higher risk of cerebellar injury.
Preterm infants with surgical NEC with positive blood culture sepsis, PDA, and severe intestinal hemorrhagic lesions (grade 3-4) appear at greater risk for cerebellar injury.
早产儿存在小脑损伤的风险，且与坏死性小肠结肠炎（NEC）相关的小脑损伤的危险因素尚未完全明确。
确定手术治疗的坏死性小肠结肠炎（NEC）患儿小脑损伤的危险因素。
对在相当于胎龄的足月时进行脑 MRI 检查发现存在小脑损伤的手术 NEC 患儿（21/65，32.3%）与未发现小脑损伤的患儿（25/44，56.8%）的临床/病理资料进行回顾性比较。我们在脑 MRI 上识别出的小脑损伤模式包括小脑出血、含铁血黄素沉着和/或小脑体积缩小。
与 NEC 后发生的动脉导管未闭（PDA）（18/21（85.7%）vs. 25/44（56.8%）；p=0.021）和血培养阳性脓毒症（13/21（61.9%）vs. 11/44（25%）；p=0.004）相关，NEC 后发生的血培养阳性脓毒症、PDA 与早产儿的小脑损伤有关，且更易发生革兰阳性菌感染（9/21（42.9%）vs. 4/44（9.1%）；p=0.001）、更高的红细胞输注量、更高的 NEC 后胆汁淤积发生率以及肠组织病理学差异（更多的出血和修复性病变）。在单变量分析中，存在小脑损伤的患儿更易发生更高级别的脑白质损伤（14/21（66.7%）vs. 4/44（9.1%）；p=0.0005）和更高级别的 ROP（70.6% vs. 38.5%；p=0.027）。在多变量回归中，阳性血培养脓毒症（OR 3.9，CI 1.1-13.7，p=0.03）、PDA（OR 4.5，CI 1.0-19.9，p=0.04）和严重肠道病理性出血（3-4 级）（OR 16.9，CI 2.1-135.5，p=0.007）与更高的小脑损伤风险独立相关。
在发生手术治疗的 NEC 的早产儿中，阳性血培养脓毒症、PDA 和严重肠道出血性病变（3-4 级）的患儿出现小脑损伤的风险更高。
