Brain injury in preterm infants with surgical necrotizing enterocolitis: clinical and bowel pathological correlates.
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
09
02
2021
accepted:
21
05
2021
revised:
19
05
2021
pubmed:
10
6
2021
medline:
25
5
2022
entrez:
9
6
2021
Statut:
ppublish
Résumé
The objective of this study was to determine the risk factors and outcomes of white matter brain injury (WMBI) on magnetic resonance imaging (MRI) at term-equivalent age in infants with surgical necrotizing enterocolitis (NEC). This retrospective study compared clinical/pathological information between infants with and those without WMBI. Out of 69 infants with surgical NEC, 17 (24.6%) had mild WMBI, 13 (18.8%) had moderate WMBI, and six (8.7%) had severe WMBI on the brain MRI. Several clinical factors (gestational age, more red blood cell (RBC) transfusions before NEC onset, pneumoperitoneum, earlier NEC onset age, postoperative ileus, acute kidney injury (AKI) by serum creatinine, postnatal steroids, hospital stay) and histopathological findings (necrosis, hemorrhage) had univariate associations with WMBI. Associations with RBC transfusion (odds ratio (OR) 23.6 [95% confidence interval (CI): 4.73-117.97]; p = 0.0001), age at NEC onset (OR 0.30 [95%CI: 0.11-0.84]; p = 0.021), necrosis (OR 0.10 [95%CI: 0.01-0.90]; p = 0.040), and bowel hemorrhage (OR 7.79 [95%CI: 2.19-27.72]; p = 0.002) persisted in multivariable association with grade 3-4 WMBI. The infants with WMBI had lower mean motor, cognitive, language scores, and higher ophthalmic morbidity at 2 years of age. The WMBI was most likely associated with earlier NEC onset, higher RBC transfusions, and less necrosis and greater hemorrhage lesions on intestinal pathology in preterm infants with surgical NEC. In preterm infants with surgical NEC, brain MRI showed injury in the white matter in 52%, gray matter in 10%, and cerebellar region in 30%. Preterm infants with severe WMBI (grade 3-4) had less necrosis and greater hemorrhagic lesions on histopathology of the bowel. Preterm infants with WMBI were more likely to have a more severe postoperative course, AKI, and longer length of hospitalization. Neuroprotective strategies to prevent brain injury in preterm infants with surgical NEC are needed with the goal of improving the neurodevelopmental outcomes.
Sections du résumé
BACKGROUND
The objective of this study was to determine the risk factors and outcomes of white matter brain injury (WMBI) on magnetic resonance imaging (MRI) at term-equivalent age in infants with surgical necrotizing enterocolitis (NEC).
METHODS
This retrospective study compared clinical/pathological information between infants with and those without WMBI.
RESULTS
Out of 69 infants with surgical NEC, 17 (24.6%) had mild WMBI, 13 (18.8%) had moderate WMBI, and six (8.7%) had severe WMBI on the brain MRI. Several clinical factors (gestational age, more red blood cell (RBC) transfusions before NEC onset, pneumoperitoneum, earlier NEC onset age, postoperative ileus, acute kidney injury (AKI) by serum creatinine, postnatal steroids, hospital stay) and histopathological findings (necrosis, hemorrhage) had univariate associations with WMBI. Associations with RBC transfusion (odds ratio (OR) 23.6 [95% confidence interval (CI): 4.73-117.97]; p = 0.0001), age at NEC onset (OR 0.30 [95%CI: 0.11-0.84]; p = 0.021), necrosis (OR 0.10 [95%CI: 0.01-0.90]; p = 0.040), and bowel hemorrhage (OR 7.79 [95%CI: 2.19-27.72]; p = 0.002) persisted in multivariable association with grade 3-4 WMBI. The infants with WMBI had lower mean motor, cognitive, language scores, and higher ophthalmic morbidity at 2 years of age.
CONCLUSIONS
The WMBI was most likely associated with earlier NEC onset, higher RBC transfusions, and less necrosis and greater hemorrhage lesions on intestinal pathology in preterm infants with surgical NEC.
IMPACT
In preterm infants with surgical NEC, brain MRI showed injury in the white matter in 52%, gray matter in 10%, and cerebellar region in 30%. Preterm infants with severe WMBI (grade 3-4) had less necrosis and greater hemorrhagic lesions on histopathology of the bowel. Preterm infants with WMBI were more likely to have a more severe postoperative course, AKI, and longer length of hospitalization. Neuroprotective strategies to prevent brain injury in preterm infants with surgical NEC are needed with the goal of improving the neurodevelopmental outcomes.
Identifiants
pubmed: 34103675
doi: 10.1038/s41390-021-01614-3
pii: 10.1038/s41390-021-01614-3
pmc: PMC10308193
mid: NIHMS1910453
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1182-1195Subventions
Organisme : NIGMS NIH HHS
ID : U54 GM115428
Pays : United States
Informations de copyright
© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
Références
J Pediatr. 2014 Feb;164(2):410-2.e1
pubmed: 24210927
J Perinatol. 2018 Oct;38(10):1386-1390
pubmed: 30087454
Pediatr Nephrol. 2018 Mar;33(3):503-510
pubmed: 28983789
Semin Fetal Neonatal Med. 2018 Dec;23(6):416-419
pubmed: 30145059
N Engl J Med. 2011 Jan 20;364(3):255-64
pubmed: 21247316
Arch Dis Child Fetal Neonatal Ed. 2018 Sep;103(5):F461-F466
pubmed: 29092912
Lancet Child Adolesc Health. 2017 Nov;1(3):184-194
pubmed: 29732396
Pediatr Res. 2014 Jul;76(1):100-8
pubmed: 24732104
J Neuroinflammation. 2019 May 10;16(1):97
pubmed: 31077225
Pediatr Res. 2021 Jul;90(1):109-116
pubmed: 33432157
J Perinatol. 2020 Nov;40(11):1671-1678
pubmed: 32669645
PLoS One. 2015 May 12;10(5):e0125769
pubmed: 25965063
Pediatr Res. 2015 Nov;78(5):527-32
pubmed: 26270572
Pediatrics. 2005 Dec;116(6):1353-60
pubmed: 16322158
Dev Neurosci. 2018;40(3):198-208
pubmed: 29874640
Neuroimage Clin. 2017 Nov 21;17:596-606
pubmed: 29234596
PLoS One. 2019 May 16;14(5):e0215351
pubmed: 31095575
Neonatology. 2016;110(2):148-54
pubmed: 27105356
Pediatrics. 1975 Mar;55(3):376-87
pubmed: 1143976
Pediatrics. 2007 Sep;120(3):584-93
pubmed: 17766532
JAMA. 2015 Sep 8;314(10):1039-51
pubmed: 26348753
J Pediatr. 2008 Aug;153(2):170-5, 175.e1
pubmed: 18534228
Clin Perinatol. 2014 Sep;41(3):487-502
pubmed: 25155722
Anesthesiology. 2012 May;116(5):1139-48
pubmed: 22415388
N Engl J Med. 2006 Aug 17;355(7):685-94
pubmed: 16914704
Pediatrics. 2015 Jan;135(1):e32-42
pubmed: 25554820
Pediatr Res. 2017 Oct;82(4):569-573
pubmed: 28604760
Brain Behav Immun. 2010 Jul;24(5):747-58
pubmed: 19861157
BMC Pediatr. 2013 Aug 20;13:127
pubmed: 23962093
Pediatr Res. 2021 Jan;89(1):163-170
pubmed: 32438367
Transfusion. 2017 May;57(5):1304-1310
pubmed: 28295397
J Pediatr Gastroenterol Nutr. 2004 Oct;39(4):366-72
pubmed: 15448426
Front Pediatr. 2016 Jul 19;4:68
pubmed: 27486571
Handb Clin Neurol. 2018;155:49-59
pubmed: 29891076
Ann Surg. 1978 Jan;187(1):1-7
pubmed: 413500
J Pediatr. 2008 Aug;153(2):160-3
pubmed: 18639727
Pediatr Res. 2014 Mar;75(3):431-5
pubmed: 24296799
Sci Transl Med. 2018 Dec 12;10(471):
pubmed: 30541786
Sci Transl Med. 2021 Jan 6;13(575):
pubmed: 33408187
Curr Probl Surg. 2019 Jan;56(1):11-38
pubmed: 30691547
Pediatrics. 2015 Aug;136(2):e463-73
pubmed: 26169430
BMJ Paediatr Open. 2018 Dec 04;2(1):e000316
pubmed: 30613802