Abstract
BackgroundNecrotizing enterocolitis (NEC) is a devastating disease in preterm infants with significant morbidities, including neurodevelopmental impairment (NDI). This study aimed to investigate whether NEC is associated with (1) brain volume expansion and white matter maturation using diffusion tensor imaging analysis and (2) NDI compared with preterm infants without NEC.MethodsWe included 86 preterm infants (20 with NEC and 66 without NEC) with no evidence of brain abnormalities on trans-fontanelle ultrasonography and magnetic resonance imaging at term-equivalent age (TEA). Regional brain volume analysis and white matter tractography were performed to study brain microstructure alterations. NDI was assessed using the Bayley Scales of Infant and Toddler Development-III (BSID-III) at 18 months of corrected age (CA).ResultsPreterm infants with NEC showed significantly high risk of motor impairment (odds ratio 58.26, 95% confidence interval 7.80–435.12, p < 0.001). We found significantly increased mean diffusivity (MD) in the splenium of corpus callosum (sCC) (p = 0.001) and the left corticospinal tract (p = 0.001) in preterm infants with NEC. The sCC with increased MD showed a negative association with the BSID-III language (p = 0.025) and motor scores (p = 0.002) at 18 months of CA, implying the relevance of sCC integrity with later NDI.ConclusionThe white matter microstructure differed between preterm infants with and without NEC. The prognostic value of network parameters of sCC at TEA may provide better information for the early detection of NDI in preterm infants.
Highlights
Necrotizing enterocolitis (NEC) is a devastating disease in preterm infants with significant morbidities, including neurodevelopmental impairment (NDI)
Background standardized feeding protocols, including breast milk feeding, have been implemented, necrotizing enterocolitis (NEC) remains a devastating disease in the neonatal intensive care unit (NICU) that can lead to neurodevelopmental impairment (NDI) in preterm infants
The NEC group was defined as preterm infants who were diagnosed with NEC stage II or greater according to Bell’s Modified staging criteria [12]
Summary
Necrotizing enterocolitis (NEC) is a devastating disease in preterm infants with significant morbidities, including neurodevelopmental impairment (NDI). This study aimed to investigate whether NEC is associated with (1) brain volume expansion and white matter maturation using diffusion tensor imaging analysis and (2) NDI compared with preterm infants without NEC. Standardized feeding protocols, including breast milk feeding, have been implemented, necrotizing enterocolitis (NEC) remains a devastating disease in the neonatal intensive care unit (NICU) that can lead to neurodevelopmental impairment (NDI) in preterm infants. There has been a great deal of interest in using diffusion anisotropy as a marker for white matter tract integrity in DTI, reflecting structural and functional alterations in the developing preterm brain. Little is known about the impact and clinical implications of NEC on brain development between birth and term-equivalent age (TEA) in terms of altered white matter maturation. There have been few attempts to elucidate whether NEC is associated with white matter maturation; few studies have shown confounding results, and their relationship has yet to be established [9, 10]
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