Masahiro Hayakawa1, Tomoaki Taguchi2, Naoto Urushihara3, Akiko Yokoi4, Hiroshi Take5, Jun Shiraishi6, Hideshi Fujinaga7, Kensuke Ohashi8, Makoto Oshiro9, Yuichi Kato10, Satoko Ohfuji11, Hiroomi Okuyama12,13. 1. Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan. 2. Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 3. Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. 4. Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan. 5. Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan. 6. Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Tokyo, Japan. 7. Division of Neonatology, Center for Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan. 8. Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan. 9. Department of Neonatology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan. 10. Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan. 11. Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan. 12. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan. 13. Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Abstract
BACKGROUND: Surgical intestinal disorders, such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in very low-birthweight infants (VLBWI). The aim of this study was to compare the composite outcomes of death or neurodevelopmental impairment (NDI) in VLBWI with surgical intestinal disorders and assess independent risk factors for death and NDI at 18 months of corrected age. METHODS: A retrospective matched-cohort study was conducted at 11 institutes. We included VLBWI who had undergone laparotomy for NEC, FIP, and MRI. Two control subjects were chosen for every surgical patient and matched for gestational age and birthweight to form the comparison group. Death and neurodevelopmental outcome at 18 months of corrected age were evaluated. RESULTS: The number of infants in the NEC, FIP, MRI, and control groups was 44, 47, 42, and 261, respectively. In-hospital mortality was higher in infants with NEC and MRI relative to those in the control group (P < 0.001). The incidence rate for NDI at 18 months of corrected age was higher in infants with MRI relative to those in the control group (P = 0.021). On logistic regression analysis, low gestational age, male sex, small for gestational age, intraventricular hemorrhage, and MRI were associated with increased risk of death or NDI at 18 months of corrected age. CONCLUSIONS: NEC and MRI were associated with in-hospital mortality, and MRI was associated with NDI or death at 18 months of corrected age.
BACKGROUND: Surgical intestinal disorders, such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in very low-birthweight infants (VLBWI). The aim of this study was to compare the composite outcomes of death or neurodevelopmental impairment (NDI) in VLBWI with surgical intestinal disorders and assess independent risk factors for death and NDI at 18 months of corrected age. METHODS: A retrospective matched-cohort study was conducted at 11 institutes. We included VLBWI who had undergone laparotomy for NEC, FIP, and MRI. Two control subjects were chosen for every surgical patient and matched for gestational age and birthweight to form the comparison group. Death and neurodevelopmental outcome at 18 months of corrected age were evaluated. RESULTS: The number of infants in the NEC, FIP, MRI, and control groups was 44, 47, 42, and 261, respectively. In-hospital mortality was higher in infants with NEC and MRI relative to those in the control group (P < 0.001). The incidence rate for NDI at 18 months of corrected age was higher in infants with MRI relative to those in the control group (P = 0.021). On logistic regression analysis, low gestational age, male sex, small for gestational age, intraventricular hemorrhage, and MRI were associated with increased risk of death or NDI at 18 months of corrected age. CONCLUSIONS: NEC and MRI were associated with in-hospital mortality, and MRI was associated with NDI or death at 18 months of corrected age.
Authors: Brian P Blackwood; Douglas R Wood; Carrie Yuan; Joseph Nicolas; Isabelle G De Plaen; Kathryn N Farrow; Pauline Chou; Jerrold R Turner; Catherine J Hunter Journal: Am J Pathol Date: 2016-12-08 Impact factor: 4.307