Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Intestinal Perforation in Very Low Birth Weight Infants: Growth and Neurodevelopment at 1 Year of Age

Journal of Perinatology volume 25, pages 583–589 (2005)Cite this article

Abstract

OBJECTIVE:

To compare growth and neurodevelopment in surviving very low birth weight (VLBW) infants with an intestinal perforation (IP) caused by necrotizing enterocolitis (NEC) versus spontaneous intestinal perforation (SIP).

STUDY DESIGN:

Retrospective, observational cohort study. Infants born between January 1996 and December 1999 with birth weight <1500?g and a diagnosis of intestinal perforation were identified and data extracted from NICU, surgical and hospital databases.

RESULTS:

IP was identified in 62 of 1357 VLBW infants (5%); 39 infants (63%) had surgical NEC and 23 (37%) had SIP. Among survivors, 21/28 with surgical NEC (75%) and 13/18 with SIP (72%) returned for follow-up. At 1-year adjusted age, there were no differences in growth parameters but the Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) were lower in survivors with NEC versus SIP (mean difference in MDI=15; 95% confidence limits=3, 28; p=0.02; mean difference in PDI=14; 95% confidence limits=0.4, 28; p=0.04).

CONCLUSIONS:

Intestinal perforation caused by NEC, as compared to SIP, is associated with worse neurodevelopmental outcome at 1 year.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Kliegmann RM, Faranoff AA . Neonatal necrotizing enterocolitis: a nine-year experience, part 1/2. Am J Dis Child 1981;135:603–611.

    Article  Google Scholar 

  2. Aschner JL, Deluga KS, Metlay LA, Emmens RW, Hendricks-Munoz KD . Spontaneous focal perforation in very low birth weight infants. J Pediatr 1988;113:364–367.

    Article  CAS  Google Scholar 

  3. Meyers CL, Payne NR, Roback SA . Spontaneous isolated intestinal perforation in neonates with birth weight &lt;1,000?g, not associated with necrotizing enterocolitis. J Pediatr Surg 1991;26:714–717.

    Article  Google Scholar 

  4. Adderson EE, Pappin A, Pavia AT . Spontaneous intestinal perforation in premature infants: a distinct clinical entity associated with systemic candidiasis. J Pediatr Surg 1998;33:1463–1467.

    Article  CAS  Google Scholar 

  5. Buchheit JQ, Stewart DL . Clinical comparison of localized intestinal perforation and necrotizing enterocolitis in neonates. Pediatrics 1994;93:32–36.

    CAS  PubMed  Google Scholar 

  6. Touloukian RJ . Gastric Ischemia: the primary factor in neonatal perforations. Clin Pediatr 1973;12:219–225.

    CAS  Google Scholar 

  7. Borzotta AP, Groff DB . Gastrointestinal perforation in infants. Am J Surg 1988;155:447–452.

    Article  CAS  Google Scholar 

  8. Ladd AP, Rescorla FJ, West KW, Scherer III LR, Engum SA, Grosfeld JL . Long-term follow-up after resection for necrotizing enterocolitis: factors affecting outcome. J Pediatr Surg 1998;33:967–972.

    Article  CAS  Google Scholar 

  9. Walsh MC, Kliegman RM, Hack M . Severity of necrotizing enterocolitis: influence on outcome at 2 years of age. Pediatrics 1989;84:808–814.

    CAS  PubMed  Google Scholar 

  10. Vohr BR, Wright LL, Dusick AM, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Developmental Neonatal Research Network, 1993–1994. Pediatrics 2000;105:1216–1226.

    Article  CAS  Google Scholar 

  11. Sonntag J, Grimmer I, Scholz T, Metze B, Wit J, Obladen M . Growth and neurodevelopmental outcome of very low birth weight infants with necrotizing enterocolitis. Acta Paediatr 2000;89:528–532.

    Article  CAS  Google Scholar 

  12. Salhab WA, Perlman JM, Silver L, Broyles RS . Necrotizing enterocolitis and neurodevelopmental outcome in extremely low birth weight infants &lt;1000?g. J Perinatol 2004;24:534–540.

    Article  Google Scholar 

  13. Bell MJ . Perforation of the gastrointestinal tract and peritonitis in the neonate. Surg Gynecol Obstet 1985;160:20–26.

    CAS  PubMed  Google Scholar 

  14. Hamill PVV, Drizd TA, Johnson CL, Reed RB, Roche AF, Moore WM . Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr 1979;32:607–629.

    Article  CAS  Google Scholar 

  15. Stark AR, Carlo WA, Tyson JE, et al. Adverse effects of early dexamethasone in extremely low birth weight infants. National Institute of Child Health and Human Development Neonatal Research Network. N Engl J Med 2001;344:95–101.

    Article  CAS  Google Scholar 

  16. Gordon PV, Young ML, Marshall DD . Focal small bowel perforation: an adverse effect of early postnatal dexamethasone therapy in extremely low birth weight infants. J Perinatol 2001;21:156–160.

    Article  CAS  Google Scholar 

  17. Halliday HL, Ehrenkranz RA . Early postnatal (&lt;96 hours) corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev 2000;2:CD001146 Review. Update in: Cochrane Database Syst Rev. 2001; 1: CD001146.

    Google Scholar 

  18. Watterberg KL, Gerdes JS, Cole CH, et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics 2004;114:1649–1657.

    Article  Google Scholar 

  19. Kothadia JM, O'Shea TM, Roberts D, Auringer ST, Weaver III RG, Dillard RG . Randomized placebo-controlled trial of a 42-day tapering course of dexamethasone to reduce the duration of ventilator dependency in very low birth weight infants. Pediatrics 1999;104:22–27.

    Article  CAS  Google Scholar 

  20. Hack M, Breslau N, Weissman B, Aram D, Klein N, Borawski E . Effect of very low birth weight and subnormal head size on cognitive abilities at school age. N Engl J Med 1991;325:231–237.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Nancy Peters for her assistance in identifying study subjects, and Barbara Jackson, Robert Dillard, Kurt Klinepeter and Donald Goldstein for performing follow-up assessments on the study subjects. This study was funded in part by the North Carolina Department of Health and Human Services.

Author information

Author notes

  1. Timothy M Morgan: Statistical Reviewer: Timothy M. Morgan, PhD, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Authors and Affiliations

  1. Department of Pediatrics (O.A.A., T.M.O.), Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Olubukunola A Adesanya MD, MSPH & T Michael O'Shea MD, MPH

  2. Department of Surgery (C.S.T.), Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Charles S Turner MD

  3. Department of Public Health Sciences (R.M.A., T.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Robert M Amoroso BS & Timothy M Morgan PhD

  4. Department of Pediatrics and the Vanderbilt Kennedy Center (J.L.A.), Vanderbilt University Medical Center, Nashville, TN, USA

    Judy L Aschner MD

Authors
  1. Olubukunola A Adesanya MD, MSPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T Michael O'Shea MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles S Turner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert M Amoroso BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Timothy M Morgan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Judy L Aschner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adesanya, O., O'Shea, T., Turner, C. et al. Intestinal Perforation in Very Low Birth Weight Infants: Growth and Neurodevelopment at 1 Year of Age. J Perinatol 25, 583–589 (2005). https://doi.org/10.1038/sj.jp.7211360

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211360

This article is cited by

Search

Advanced search

Quick links