Neurodevelopmental and Growth Outcomes of Extremely Preterm Infants with Short Bowel Syndrome

J Pediatr. 2021 Mar;230:76-83.e5. doi: 10.1016/j.jpeds.2020.11.026. Epub 2020 Nov 24.

Mercedes Bell 1, Conrad R Cole 2, Nellie I Hansen 3, Andrea F Duncan 4, Susan R Hintz 5, Ira Adams-Chapman 6, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network


Author information

  • 1The Permanente Medical Group, Kaiser Oakland Medical Center, Oakland, CA.
  • 2Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. Electronic address: Conrad.Cole@cchmc.org.
  • 3Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC.
  • 4Department of Pediatrics, University of Pennsylvania, Philadelphia, PA.
  • 5Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA.
  • 6Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA.


Objective: To determine if preterm infants with surgical necrotizing enterocolitis (sNEC) or spontaneous intestinal perforation (SIP) with short bowel syndrome (SBS) have worse neurodevelopmental and growth outcomes than those with sNEC/SIP without SBS, and those with no necrotizing enterocolitis, SIP, or SBS.

Study design: We undertook a retrospective analysis of prospectively collected data from infants born between 22 and 26 weeks of gestation in the National Institute of Child Health and Human Development Neonatal Research Network centers from January 1, 2008, to December 31, 2016. Survivors were assessed at 18-26 months corrected age by standardized neurologic examination and Bayley Scales of Infant and Toddler Development, Third Edition. The primary outcome was moderate-severe neurodevelopmental impairment. Growth was assessed using World Health Organization z-score standards. Adjusted relative risks were estimated using modified Poisson regression models.

Results: Mortality was 32%, 45%, and 21% in the 3 groups, respectively. Eighty-nine percent of survivors were seen at 18-26 months corrected age. Moderate-severe neurodevelopmental impairment was present in 77% of children with SBS compared with 62% with sNEC/SIP without SBS (adjusted relative risk, 1.22; 95% CI, 1.02-1.45; P = .03) and 44% with no necrotizing enterocolitis, SIP, or SBS (adjusted relative risk, 1.60; 95% CI, 1.37-1.88; P < .001). Children with SBS had lowcognitive, language, and motor scores than children with sNEC/SIP without SBS. At follow-up, length and head circumference z-scores remained more than 1 SD below the mean for children with SBS.

Conclusions: Preterm infants with sNEC/SIP and SBS had increased risk of adverse neurodevelopmental outcomes at 18-26 months corrected age and impaired growth compared with peers with sNEC/SIP without SBS or without any of these conditions.

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