A. Gaibi-Rodriguez2, Z. Plona2, T. Gennell6, D. Midura6, R. Kim3, L. Manganas5, E. Speer4, E. Fallon6, H. Hsieh1 1Stony Brook University Medical Center, Division Of Pediatric Surgery, Stony Brook, NY, USA 2Stony Brook University Medical Center, Department Of Surgery, Stony Brook, NY, USA 3Stony Brook University Medical Center, Renaissance School Of Medicine, Stony Brook, NY, USA 4Stony Brook University Medical Center, Department Of Pediatrics, Stony Brook, NY, USA 5NYU Winthrop University Hospital, Department Of Neurology, Garden City, NY, USA 6New York-Presbyterian Morgan Stanley Children’s Hospital, Department Of Surgery, New York, NEW YORK, USA
Introduction: Necrotizing enterocolitis (NEC) is a devastating disease of prematurity with a mortality rate of 15 – 30%, depending upon disease severity (Niemarkt et al., 2019). One of the most serious consequences of NEC is the cognitive and neurodevelopmental deficits. NEC severity has been shown to correlate with the severity of cognitive effects and anatomical defects. We sought to determine if NEC severity impacts subsequent neurological outcomes and/or anatomy in patients.
Methods: A retrospective review of NEC (Bell’s class II/III) patients treated at two tertiary children’s hospitals between January 2009 and December 2019 was performed. Demographic, birth data and gestational age were recorded. Survival, length of stay, days NPO, TPN use, head circumference, length and weight were measured. Post-discharge diagnosis of neurological deficits, abnormal neurological imaging and need for early intervention were also recorded.
Results: Of the 94 patients identified, 63% (n=59) patients were treated medically and 37% (35) surgically. 59% (55) of patients were female; which was similarly distributed between the groups. Age at diagnosis, gestational age, birth weights, birth lengths, and birth head circumference were comparable between both groups. All ethnicities were equally represented as well. Consistent with literature, surgical NEC patients require more TPN and are NPO longer than medical patients (p=0.005). No deaths were observed in medically treated NEC patients, whereas, 43% (15) of the surgical patients died. The corrected percentage for gestational age head circumference was statistically significantly different between medically and surgically treated NEC patients 1 month and 3 months after the episode of NEC. Interestingly, the mean corrected head circumference in medically treated NEC increases to 50% by 3 months post diagnosis (Table 1).
Conclusion: Infants who have had NEC are at a greater risk for neurodevelopmental impairment. Although we do not see differences in neurological outcomes between medically and surgically treated NEC, there is a clear difference in head circumference measured between these two groups. This data are suggestive that more severe/surgical NEC may result in anatomical changes in brain anatomy that may predict/predispose patients to cognitive and developmental delay. Further prospective and multicenter studies will give further insight into understanding how NEC and NEC severity affects neurodevelopment.
