Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants

Abstract

Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy (LAP) versus peritoneal drainage (PD) impacted the likelihood of growth failure. Summary Background Data: Infants with surgical NEC and SIP have high mortality and most have neurodevelopmental impairment and poor growth. Existing literature of growth outcomes for these infants is limited. Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <−2.0) at 18-22 months. We used logistic regression including diagnosis and treatment as covariates. Secondary outcomes were analyzed using Fisher’s exact or Pearson’s Chi-squared test for categorical variables, and Wilcoxon rank sum test or one-way ANOVA for continuous variables. Results: Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18-22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). Mean weight-for-age Z-score at 18-22 months in NEC infants was -2.05±0.99 versus −1.84±1.09 SIP (P=0.2), and predicted mean weight-for-age Z-score was lower in NEC infants versus SIP (Beta −0.27; 95% CI: −0.53, −0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18-22 months were significant in all infants, but most severe (>2) in NEC infants (P=0.2). Conclusions: This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months.