Clinical determinants of intestinal failure and death in preterm infants with surgical necrotizing enterocolitis

Article type: Research Article

Authors: Garg, P.M.^{a; b; *} | Denton, M.X.^b | Talluri, R.^c | Ansari, M.A.Y.^c | Riddick, R.^b | Ostrander, M.M.^b | McDonald, A.G.^d | Premkumar, M.H.^e | Hillegass, W.B.^{c; f} | Garg, P.P.^b

Affiliations: [a] Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, NC, USA | [b] Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA | [c] Department of Data Sciences, University of Mississippi Medical Center, Jackson, MS, USA | [d] Department of Pathology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, NC, USA | [e] Department of Pediatrics/Neonatology, Texas Children Hospital, Baylor College of Medicine, Houston, TX, USA | [f] Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

Correspondence: [*] Address for correspondence: Parvesh M. Garg, Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, NC, Tel.: +252 364 5800; E-mails: gargparvesh@hotmail.com; pagarg@wakehealth.edu.

Abstract: OBJECTIVE:We sought to investigate the clinical determinants of intestinal failure and death in preterm infants with surgical NEC. METHODS:Retrospective comparison of clinical information between Group A = intestinal failure (Parenteral nutrition (PN) >90 days) and death and Group B = survivors and with PN dependence < 90 days in preterm infants with surgical NEC. RESULTS:Group A (n = 99/143) had a lower mean gestational age (26.4 weeks [SD3.5] vs. 29.4 [SD 3.5]; p = 0.013), lower birth weight (873 gm [SD 427g] vs. 1425 gm [894g]; p = <0.001), later age of NEC onset (22 days [SD20] vs. 16 days [SD 17]; p = 0.128), received surgery later (276 hours [SD 544] vs. 117 hours [SD 267]; p = 0.032), had cholestasis, received dopamine (80.6% vs. 58.5%; p = 0.010) more frequently and had longer postoperative ileus time (19.8 days [SD 15.4] vs. 11.8 days [SD 6.5]; p = <0.001) and reached full feeds later (93 days [SD 45] vs. 44 [SD 22]; p = <0.001) than Group B.On multivariate logistic regression, higher birth weight was associated with lower risk (OR 0.35, 95% CI 0.15–0.82; p = 0.016) of TPN > 90 days or death. Longer length of bowel resected (OR 1.76, 95% CI 1.02–3.02; p = 0.039) and longer postoperative ileus (OR 2.87, 95% CI 1.26–6.53; p = 0.011) were also independently associated with TPN >90days or death adjusted for gestational age and antenatal steroid treatment. CONCLUSION:In preterm infants with surgical NEC, clinical factors such as lower birth weight, longer bowel loss, and postoperative ileus days were significantly and independently associated with TPN >90 days or death.

Keywords: Intestinal failure, mortality, necrotizing enterocolitis, outcomes, preterm infants

DOI: 10.3233/NPM-230157

Journal: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 589-596, 2023