Time to full enteral feeding after necrotizing enterocolitis in preterm-born children is related to neurodevelopment at 2–3 years of age

Abstract

BackgroundNecrotizing enterocolitis (NEC) is associated with poorer neurodevelopment. It is, however, unclear which factors besides surgery affect neurodevelopment in preterm-born children surviving NEC. AimsWe determined whether time to full enteral feeding (FEFt) and post-NEC complications after NEC were associated with neurodevelopment. Study designProspective observational cohort study. SubjectsTwo to three year old preterm-born children who survived NEC (Bells stage ≥ 2). We categorized children in two groups, one group shorter and equal and one group longer than the group's median FEFt. Post-NEC complications included recurrent NEC and/or post-NEC stricture. Outcome measuresBayley Scales of Infants and Toddler Development III (Bayley-III) and Child Behavior Checklist (CBCL). Associations between Bayley-III and CBCL scores with FEFt and Post-NEC complications were determined using linear regression analyses, adjusted for severity of illness and potential confounders. ResultsWe included 44 children, median gestational age of 27.9 [IQR: 26.7–29.3] weeks, birth weight 1148 [IQR: 810–1461] grams. Median FEFt after NEC was 20 [IQR: 16–30] days. Median follow-up age was 25.7 [IQR: 24.8–33.5] months. FEFt > 20 days was associated with lower cognitive and lower motor composite scores of the Bayley-III (B: −8.6, 95% CI −16.7 to −0.4, and B: −9.0, 95% CI, −16.7 to −1.4). FEFt was not associated with CBCL scores. Post-NEC complications (n = 11) were not associated with Bayley-III scores nor with CBCL scores. ConclusionsProlonged FEFt after NEC in preterm-born children surviving NEC is associated with lower cognitive and lower motor composite scores at the age of 2–3 years. These results show the importance of limiting the duration of the nil per mouth regimen if and when possible.