Physical and neurological development of necrotizing enterocolitis in very low birth weight infants

doi:10.11852/zgetbjzz2022-0621

Abstract

Abstract: Objectives To investigate physical and neurodevelopment of neonatal necrotizing enterocolitis(NEC) in very low birth weight(VLBW) infants at correct gestational age of 3, 6, 9, and 12 months, in order to provide reference for the intervention of NEC. Method A retrospective case-control study was performed to collect data of VLBW infants with NEC and without NEC who were followed up in the Neonatal Outpatient of the Second Affiliated Hospital of Xi′an Jiaotong University from April 2018 to April 2021. The perinatal characteristics of infants in different NEC stages were analyzed, the physical and neurological development of infants in each group were compared at correct gestational age of 3, 6, 9 and 12 months. Results 1) A total of 122 cases were enrolled, including 51 cases in non-NEC group and 71 cases in NEC group. According to the modified Bell staging, there were 39 cases in NEC Stage Ⅱ and 32 cases in NEC Stage Ⅲ. There were no significant differences in birth weight, gestational age, head circumference, body length and gender among the NEC- stage Ⅱ group, stage Ⅲ group and non-NEC groups(P＞0.05). 2) There was significant difference in the physical development at correct gestational age of 3, 6, 9, and 12 months among the NEC- stage Ⅱ group, stage Ⅲ group and non-NEC groups(birth weight F=13.31, 11.16, 10.28, 8.56; body length F=11.14, 7.32, 4.72, 8.18; head circumference F=9.69, 6.88, 10.42, 7.71, P＜0.05). 3) There was significant difference in the mental developmental index(MDI)/psychomotor developmental index(PDI) scores of Bayley Scales of Infant Development-Ⅱ(BSID-Ⅱ) at correct gestational age of 3 month(F=17.58,16.72), 6 month(F=15.32,13.25), 9 month(F=18.66, 18.58), and 12 months(F=15.43, 11.45) among the NEC-stage Ⅱ group, stage Ⅲ group and non-NEC groups(P＜0.05). Conclusions Neurodevelopmental outcomes in children with NEC are related to multiple factors, including gestational age, birth weight and complications, etc. Therefore, it is supposed to pay more attention to the delicacy management of children at high risk of NEC to reduce the occurrence and severity of NEC, so as to improve the long-term prognosis of these children.

Key words: neonatal necrotizing enterocolitis, very low birth weight infants, psychomotor developmental index, mental developmental index, neurodevelopment

摘要： 目的探讨极低出生体重坏死性小肠结肠炎(NEC)患儿在纠正胎龄3月、6月、9月、12月时体格和神经发育的研究,为极低出生体重儿并发NEC的干预提供依据。方法回顾性收集2018年4月—2021年4月西安交通大学第二附属医院新生儿门诊随访的极低出生体重NEC患儿及非NEC(无NEC)患儿的临床资料。分析不同NEC分期组患儿围生期的体格特点,比较各组患儿在纠正胎龄3月、6月、9月、12月时体格及神经发育研究。结果 1)总病例数122例,无NEC组51例,NEC组71例,参考修正版Bell分期,分为NEC-Ⅱ期39例,NEC-Ⅲ期32例,三组间出生体重、胎龄、头围、身长及性别比较,差异均无统计学意义(P＞0.05);2)无NEC组、NEC-Ⅱ期、NEC-Ⅲ期组三组间在纠正胎龄3月、6月、9月、12月时体重(F值分别为13.31、11.16、10.28、8.56)、身长(F值分别为11.14、7.32、4.72、8.18)、头围(F值分别为9.69、6.88、10.42、7.71)比较,差异均有统计学意义(P＜0.05);3)无NEC组、NEC-Ⅱ期、NEC-Ⅲ期组三组间在纠正胎龄3月、6月、9月、12月龄时贝利婴幼儿发展量表Ⅱ(BSID-Ⅱ)的智能发育指数(MDI,F值分别为16.72、13.25、18.58、11.45)和精神运动发育指数(PDI,F值分别为17.58、15.32、18.66、15.43)比较,差异均有统计学意义(P＜0.05)。结论 NEC患儿体格和神经发育结局与出生胎龄、出生体重及并发症等多种因素有关,应重视NEC高危患儿的精细化管理,减少NEC发生及严重程度,改善患儿的远期预后。

关键词: 新生儿坏死性小肠结肠炎, 极低出生体重儿, 精神运动发育指数, 智能发育指数, 神经发育

CLC Number:

R722.1

WANG Hui-ping, WANG Li, GAO Qiong, BAI Bo-liang, MA Ying-jun. Physical and neurological development of necrotizing enterocolitis in very low birth weight infants[J]. Chinese Journal of Child Health Care, 2023, 31(1): 96-100.

王惠萍, 王莉, 高琼, 白铂亮, 马颖君. 极低出生体重坏死性小肠结肠炎患儿体格及神经发育的研究[J]. 中国儿童保健杂志, 2023, 31(1): 96-100.

References

[1] Patel RM, Ferguson J,Mcelroy SJ, et al. Defining necrotizing enterocolitis:Current difficulties and future opportunities[J]. Pediatric Research, 2020, 88(Suppl1):10-15.
[2] Flahive C, Schlegel A, Mezoff EA. Necrotizing enterocolitis:Updates on morbidity and mortality outcomes[J]. J Pediatr, 2020, 20(5):7-10.
[3] Zozaya C, Shah J, Pierro A, et al. Neurodevelopmental and growth outcomes of extremely preterm infants with necrotizing enterocolitis or spontaneous intestinal perforation[J]. J Pediatr Surg, 2021, 56( 2):309-316.
[4] 邵肖梅,叶鸿瑁,丘小汕. 实用新生儿学[M]. 5 版.北京:人民卫生出版社,2019.
Shao XM,Ye HM,Qiu XS.Practical neonatology[M]. 5th ed.Beijing:People′s Medical Publishing House, 2019.
[5] 周川,冯百岁.坏死性小肠结肠炎与新生儿脑损伤[J].中国实用神经疾病杂志,2021,24(5):455-460.
Zhou C, Feng BS. Necrotizing enterocolitis and neonatal brain injury[J]. Chin J Neurol,2021,24(5):455-460.
[6] 杨梦阳,姜敏.新生儿坏死性小肠结肠炎肠屏障功能障碍的研究进展[J].中国儿童保健杂志,2021,29(3):281-284.
Yang MY, Jiang M. Research progress of intestinal barrier dysfunction in neonatal necrotizing enterocolitis[J]. Chin J Child Health Care,2021,29(3):281-284.
[7] Patel RM, Denning PW. Intestinal microbiota and itsrelationship with necrotizing enterocoliti[J].Pediatr Res,2019,78(3):232-238.
[8] Miner CA,Fullmer S, Eggett DL, et al. Factors affecting the severity of necrotizing enterocolitis[J]. J Matern Fetal Neonatal Med, 2019, 26(17):1715-1719.
[9] Irtan S, Reignier PL, Durandy A, et al. Feasibility of open abdomen surgery treatment for near fatal necrotizing enterocolitis in preterm infants[J]. J Pediatr Surg,2022,57(7):1336-1341.
[10] 许光, 李碧香, 周崇高,等. 早产儿与足月儿新生儿坏死性小肠结肠炎手术治疗临床结果比较[J]. 中华新生儿科杂志(中英文), 2020, 35(4):5.
Xu G, Li BX, Zhou ZG, et al. Comparison of surgical treatment of neonatal necrotizing enterocolitis in preterm infants and full-term infants[J]. Chin J Neonatology, 2020, 35(4):5.
[11] 董会敏,宋娟,王永,等.极早早产儿坏死性小肠结肠炎的临床特征与危险因素分析[J].中国儿童保健杂志,2021,29(9):1012-1016.
Dong HM, Song J, Wang Y, et al. Clinical characteristics and risk factors of necrotizing enterocolitis in very preterm infants[J]. Chin J Child Health,2021,29(9):1012-1016.
[12] 决珍珍,宋娟,张香敏,等.新生儿坏死性小肠结肠炎并发神经发育障碍的危险因素研究[J].中国全科医学,2022,25(18):2275-2279.
Du ZZ, Song J, Zhang XM, et al. Risk factors of neonatal necrotizing enterocolitis and neurodevelopmental disorders[J]. Chin J General Practice, 2022,25(18):2275-2279.
[13] Abbasi S, Pereira GR, Johnson L, et al. Long-term assessment of growth, nutritional status, and gastrointestinal function in survivors of necrotizing enterocolitis[J]. J Pediatr, 1984, 104(4):550-554.
[14] Sonntag J. Growth and neurodevelopmental outcome of very lowbirthweight infants with necrotizing enterocolitis[J]. Acta Pdiatrica, 2010, 89(5):528-532.
[15] Walsh M. Severity of necrotizing enterocolitis:Influence on outcome at 2 years of age[J]. Pediatrics, 1989, 84(5):808-814.
[16] 林慧佳, 施丽萍, 杜立中.新生儿坏死性小肠结肠炎患儿的远期预后[J].中国当代儿科杂志,2018,20(12):985-989.
Lin HJ, Shi LP, Du LZ. Long-term prognosis of neonates with necrotizing enterocolitis[J]. Chin J Contemp Pediatr,2018,20(12):985-989.
[17] Martin CR, Dammann O, Allred EN, et al. Neurodevelopment of extremely preterm infants who had necrotizing enterocolitis with or without late Bacteremia[J]. J Pediatr, 2010, 157(5):751-756.
[18] Tang Q, Zhang L, Li H, et al. The fetal inflammation response syndrome and adverse neonatal outcomes:A Meta-analysis[J]. J Matern Fetal Neonatal Med,2021,34(23):3902-3914.
[19] Morriss FH, Saha S, Bell EF, et al. Surgery and neurodevelopmental outcome of very low-birth-weight infants[J]. JAMA Pediatr, 2014, 168(8):746-754.
[20] Duci M, Frigo AC, Visentin S, et al. Maternal and placental risk factors associated with the development of necrotizing enterocolitis(NEC) and its severity[J]. J Pediatr Surg,2019, 54(10):2099-2102.
[21] Heida FH,Hulscher JBF,Schurink M,et al. Bloodstream infections during the onset of necrotizing enterocolitis and their relation with the pro-inflammatory response, gut wall integrity and severity of disease in NEC[J]. J Pediatr Surg, 2015,50(11):1837-1841.