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Context of time on intestinal injury in preterm infants

Pediatric Research volume 95, pages 873–874 (2024)Cite this article

In this edition of Pediatric Research, Garg et al. report on a retrospective single-center study to identify clinical epidemiologic determinants and outcomes among a cohort of infants for surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP).1 A priori, Garg et al. stratified cases based on the timing of onset, <10, 10–20, or >20 days. They found that neonates with surgical NEC/SIP at an onset >20 days had more severe necrosis and bowel loss than those with earlier onset at <10 days. The analysis is highly detailed and while the cohort is small (n = 151), probing questions were raised.

The approach taken to reach their conclusions highlights important methodological principles when studying an entity, such as intestinal injury, that is expressed variably across development and lacks precise phenotypic definitions across a wide range of risks, clinical presentations, and outcomes. To overcome these challenges, it is important to adhere to methodological principles that align with existing knowledge and establish parameters that enable reproducibility and facilitate comparisons among studies. Central to this point is adhering to precise case criteria and the handling of time.

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References

  1. Garg, P. M. et al. Outcomes by disease onset, sex, and intervention in neonates with sip and surgical NEC. Pediatr. Res. https://doi.org/10.1038/s41390-023-02749-1 (2023).

  2. Gonzalez-Rivera, R., Culverhouse, R. C., Hamvas, A., Tarr, P. I. & Warner, B. B. The age of necrotizing enterocolitis onset: an application of Sartwell’s incubation period model. J. Perinatol. 31, 519–523 (2011).

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  4. Blakely, M. L. et al. Initial laparotomy versus peritoneal drainage in extremely low birthweight infants with surgical necrotizing enterocolitis or isolated intestinal perforation: a multicenter randomized clinical trial. Ann. Surg. 274, e370–e380 (2021).

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Authors and Affiliations

  1. Division of Neonatology, Weill Cornell Medicine, New York, NY, USA

    Jayasree Nair & Camilia R. Martin

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  1. Jayasree Nair
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  2. Camilia R. Martin
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Correspondence to Camilia R. Martin.

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Competing interests

J.N. reports no conflicts of interest. C.R.M. serves on the advisory boards of Plakous Therapeutics, Lactalogics, and Vitara Biomedical, as a consultant for Baxter, and receives research support from Reckitt/Mead Johnson Nutrition.

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Nair, J., Martin, C.R. Context of time on intestinal injury in preterm infants. Pediatr Res 95, 873–874 (2024). https://doi.org/10.1038/s41390-023-02844-3

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