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Association between neurodevelopmental outcomes and concomitant presence of NEC and IVH in extremely low birth weight infants



To quantify the association between necrotizing enterocolitis (NEC) and neurodevelopmental disability (NDI) in extremely low birth weight (ELBW) infants with intraventricular hemorrhage (IVH).

Study design

ELBW survivors born 2011–2017 and evaluated at 16–26 months corrected age in the Vermont Oxford Network (VON) ELBW Follow-Up Project were included. Logistic regression determined the adjusted relative risk (aRR) of severe NDI in medical or surgical NEC compared to no NEC, stratified by severity of IVH.


Follow-up evaluation occurred in 5870 ELBW survivors. Compared to no NEC, medical NEC had no impact on NDI, regardless of IVH status. Surgical NEC increased risk of NDI in patients with no IVH (aRR 1.69; 95% CI 1.36–2.09), mild IVH (aRR 1.36;0.97–1.92), and severe IVH (aRR 1.35;1.13–1.60).


ELBW infants with surgical NEC carry increased risk of neurodevelopmental disability within each IVH severity stratum. These data describe the additive insult of surgical NEC and IVH on neurodevelopment, informing prognostic discussions and highlighting the need for preventative interventions.

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Fig. 1: Incidence of severe neurodevelopmental disability in infants with necrotizing enterocolitis (NEC) and intraventricular hemorrhage (IVH).
Fig. 2: Forest plot of adjusted risk ratios (ARR) for severe neurodevelopmental disability.

Data availability

The code used for this analysis can be made available upon request.


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We thank our colleagues who submit data to VON on behalf of infants and their families. Abstract previously presented at the annual meeting of the American Pediatric Surgical Association (APSA).

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Authors and Affiliations



KC was involved in analysis, interpretation of data, drafting of the manuscript, and critical revision of the manuscript. JK, TJ, and BPM were involved in study conception and design, analysis, interpretation of data, and critical revision of the manuscript. GK and EN were involved in analysis, interpretation of data, and critical revision of the manuscript. EME and KAM were involved in designing the data collection instruments, the acquisition of the data, interpretation of data, and critical revision of the manuscript. RFS and JDH were involved in coordinating data collection, interpretation of the data, and critical revision of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Biren P. Modi.

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Competing interests

JDH, RFS, and KAM are employees of the Vermont Oxford Network. EME receives salary support from Vermont Oxford Network. The remaining authors do not have financial relationships to disclose.

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Culbreath, K., Keefe, G., Nes, E. et al. Association between neurodevelopmental outcomes and concomitant presence of NEC and IVH in extremely low birth weight infants. J Perinatol (2023).

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