Clinical correlates of cerebellar injury in preterm infants with surgical necrotizing enterocolitis

Article type: Research Article

Authors: Garg, P.M.^{a; b; *} | Pittman, I.^b | Yi, J.^c | Shetty, A.^d | Taylor, C.^e | Reddy, K.^e | Inder, T.E.^f | Varshney, N.^g | Hillegass, W.B.^{h; i} | Garg, P.P.^b

Affiliations: [a] Department of Pediatrics/Neonatology, Wake Forest University, Winston Salem, NC, USA | [b] Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA | [c] Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, NC, USA | [d] Department of Pediatrics/Infectious Disease, Wake Forest University, Winston Salem, NC, USA | [e] Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA | [f] Children Hospital of Orange County, University of California, Irvine, Orange, CA, USA | [g] Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA | [h] Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA | [i] Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA

Correspondence: [*] Address for correspondence: Parvesh M. Garg, Department of Pediatrics/Neonatology, Wake Forest University, Winston Salem, NC, 27157, USA. Tel.: +1 252 364 5800; E-mail: gargparvesh@hotmail.com.

Abstract: BACKGROUND:The preterm infants are at risk of cerebellar injury and the risk factors for necrotizing enterocolitis (NEC) associated cerebellar injury are not fully understood. AIM:Determine the risk factors of cerebellar injury in infants with surgical necrotizing enterocolitis (NEC). METHODS:Retrospective study compared clinical/pathological information between surgical NEC infants with and those without cerebellar injury detected on brain MRI obtained at term equivalent age. Cerebellar Injury patterns that we identified on MRI brain were cerebellar hemorrhage, siderosis and/or cerebellar volume loss. RESULTS:Cerebellar injury (21/65, 32.3%) in preterm infants with NEC was associated with patent ductus arteriosus (PDA) (18/21(85.7%) vs. 25/44(56.8%); p = 0.021), blood culture positive sepsis (13/21 (61.9%) vs. 11/44 (25%); p = 0.004) following NEC, predominantly grew gram positive bacteria (9/21(42.9%) vs. 4/44(9.1%); p = 0.001), greater red cell transfusion, higher rates of cholestasis following NEC and differences in intestinal histopathology (more hemorrhagic and reparative lesions) on univariate analysis. Those with cerebellar injury had higher grade white matter injury (14/21 (66.7%) vs. 4/44(9.1%) p = 0.0005) and higher-grade ROP (70.6% vs. 38.5%; p = 0.027) than those without cerebellar injury.On multilogistic regression, the positive blood culture sepsis (OR 3.9, CI 1.1–13.7, p = 0.03), PDA (OR 4.5, CI 1.0–19.9, p = 0.04) and severe intestinal pathological hemorrhage (grade 3-4) (OR 16.9, CI 2.1–135.5, p = 0.007) were independently associated with higher risk of cerebellar injury. CONCLUSION:Preterm infants with surgical NEC with positive blood culture sepsis, PDA, and severe intestinal hemorrhagic lesions (grade 3-4) appear at greater risk for cerebellar injury.

Keywords: Brain injury, cerebellar lesions, neonate, preterm infant, surgical NEC

DOI: 10.3233/NPM-240022

Journal: Journal of Neonatal-Perinatal Medicine, vol. 17, no. 5, pp. 705-716, 2024