Abstract：
BACKGROUND: Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) affect 6-8% of extremely low birth weight (ELBW) infants. SIP has lower mortality than NEC, but with similar short-term morbidity in length of stay, growth failure, and supplemental oxygen requirements. Comparative long-term neurodevelopmental outcomes have not been clarified.
METHODS: Data were prospectively collected from 59 North American neonatal units, regarding ELBW infants (401-1000 g or 22-27 weeks gestational age) born between 2011 and 2018 and evaluated again at 16-26 months corrected age. Outcomes were collected from infants with laparotomy-confirmed NEC, laparotomy-confirmed SIP, and those without NEC or SIP. The primary outcome was severe neurodevelopmental disability. Secondary outcomes were weight <10th percentile, medical readmission, post-discharge surgery and medical support at home. Adjusted risk ratios (ARR) were calculated.
RESULTS: Of 13,673 ELBW infants, 6391 (47%) were followed including 93 of 232 (40%) with NEC and 100 of 235 (42%) with SIP. There were no statistically significant differences in adjusted risk of any outcomes when directly comparing NEC to SIP (ARR 2.35; 95% CI 0.89, 6.26). However, infants with NEC had greater risk of severe neurodevelopmental disability (ARR 1.43; 1.09-1.86), rehospitalization (ARR 1.46; 1.17-1.82), and post-discharge surgery (ARR 1.82; 1.48-2.23) compared to infants without NEC or SIP. Infants with SIP only had greater risk of post-discharge surgery (ARR 1.64; 1.34-2.00) compared to infants without NEC or SIP.
CONCLUSIONS: ELBW infants with NEC had significantly increased risk of severe neurodevelopmental disability and post-discharge healthcare needs, consistent with prior literature. We now know infants with SIP also have increased healthcare needs.
METHODS: Level II.
METHODS: Data were prospectively collected from 59 North American neonatal units, regarding ELBW infants (401-1000 g or 22-27 weeks gestational age) born between 2011 and 2018 and evaluated again at 16-26 months corrected age. Outcomes were collected from infants with laparotomy-confirmed NEC, laparotomy-confirmed SIP, and those without NEC or SIP. The primary outcome was severe neurodevelopmental disability. Secondary outcomes were weight <10th percentile, medical readmission, post-discharge surgery and medical support at home. Adjusted risk ratios (ARR) were calculated.
RESULTS: Of 13,673 ELBW infants, 6391 (47%) were followed including 93 of 232 (40%) with NEC and 100 of 235 (42%) with SIP. There were no statistically significant differences in adjusted risk of any outcomes when directly comparing NEC to SIP (ARR 2.35; 95% CI 0.89, 6.26). However, infants with NEC had greater risk of severe neurodevelopmental disability (ARR 1.43; 1.09-1.86), rehospitalization (ARR 1.46; 1.17-1.82), and post-discharge surgery (ARR 1.82; 1.48-2.23) compared to infants without NEC or SIP. Infants with SIP only had greater risk of post-discharge surgery (ARR 1.64; 1.34-2.00) compared to infants without NEC or SIP.
CONCLUSIONS: ELBW infants with NEC had significantly increased risk of severe neurodevelopmental disability and post-discharge healthcare needs, consistent with prior literature. We now know infants with SIP also have increased healthcare needs.
METHODS: Level II.
摘要：
背景：坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP）影响6-8％的极低出生体重（ELBW）婴儿。SIP的死亡率低于NEC，但是短期住院时间相似，生长失败，和补充氧气的要求。比较的长期神经发育结果尚未明确。
方法：前瞻性收集了59个北美新生儿病房的数据，关于2011年至2018年出生的ELBW婴儿（401-1000g或22-27周孕龄），并在校正年龄16-26个月时再次评估。结果是从剖腹手术证实的NEC的婴儿收集的，剖腹手术证实SIP，和那些没有NEC或SIP。主要结果是严重的神经发育障碍。次要结果是体重<10百分位数，医疗再入院,出院后手术和医疗支持在家。计算调整后的风险比（ARR）。
结果：在13,673名ELBW婴儿中，接下来是6391（47％），其中包括使用NEC的232中的93（40％）和使用SIP的235中的100（42％）。当直接比较NEC与SIP时，任何结果的校正风险均无统计学差异（ARR2.35；95％CI0.89，6.26）。然而,患有NEC的婴儿患严重神经发育障碍的风险更大（ARR1.43;1.09-1.86），再住院（ARR1.46；1.17-1.82），与没有NEC或SIP的婴儿相比，出院后手术（ARR1.82;1.48-2.23）。与没有NEC或SIP的婴儿相比，SIP的婴儿仅具有更大的出院后手术风险（ARR1.64;1.34-2.00）。
结论：患有NEC的ELBW婴儿发生严重神经发育障碍和出院后医疗需求的风险显著增加，与以前的文献一致。我们现在知道患有SIP的婴儿也增加了医疗保健需求。
方法：二级。
方法：前瞻性收集了59个北美新生儿病房的数据，关于2011年至2018年出生的ELBW婴儿（401-1000g或22-27周孕龄），并在校正年龄16-26个月时再次评估。结果是从剖腹手术证实的NEC的婴儿收集的，剖腹手术证实SIP，和那些没有NEC或SIP。主要结果是严重的神经发育障碍。次要结果是体重<10百分位数，医疗再入院,出院后手术和医疗支持在家。计算调整后的风险比（ARR）。
结果：在13,673名ELBW婴儿中，接下来是6391（47％），其中包括使用NEC的232中的93（40％）和使用SIP的235中的100（42％）。当直接比较NEC与SIP时，任何结果的校正风险均无统计学差异（ARR2.35；95％CI0.89，6.26）。然而,患有NEC的婴儿患严重神经发育障碍的风险更大（ARR1.43;1.09-1.86），再住院（ARR1.46；1.17-1.82），与没有NEC或SIP的婴儿相比，出院后手术（ARR1.82;1.48-2.23）。与没有NEC或SIP的婴儿相比，SIP的婴儿仅具有更大的出院后手术风险（ARR1.64;1.34-2.00）。
结论：患有NEC的ELBW婴儿发生严重神经发育障碍和出院后医疗需求的风险显著增加，与以前的文献一致。我们现在知道患有SIP的婴儿也增加了医疗保健需求。
方法：二级。
