1: Very Preterm Infants with Necrotizing Enterocolitis and Sepsis Demonstrate Slower Brain Metabolic Development. Issue 6 (1st June 2014)

• Record Type: Journal Article
• Authors: D'Arienzo, PD; Duerden, EG; Chau, V; Thompson, A; Belanger, S; Poskitt, KJ; Grunau, RE; Synnes, A; Miller, SP; Moore, AM
• Is Part Of: Paediatrics & Child Health. Volume 19:Issue 6(2014)
• Page Start: e36
• Page End: e36
• Publication Date: 2014-06-01
• Subjects: Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.92
• DOI: 10.1093/pch/19.6.e35-1
• Languages: English
• ISSNs: 1205-7088

Abstract

Abstract: BACKGROUND: Very preterm infants are predisposed to postnatal infections and necrotizing enterocolitis (NEC) that are associated with poor outcome and increased risk of brain injury. OBJECTIVES: To assess brain metabolic development in infants exposed to neonatal infections and NEC using indices of neuronal integrity (N-acetyl aspartate [NAA]/choline), measured with magnetic resonance spectroscopy (MRS). Hypothesis: NEC with concurrent sepsis is associated with impaired brain development, as reflected by NAA/choline ratios. DESIGN/METHODS: A total of 213 preterm born neonates (gestational age 24 to 32 weeks) recruited from two hospitals underwent MRS in the first weeks of life (32 weeks) and term-equivalent age (41 weeks). Ratios of NAA to choline were calculated from the basal ganglia. Data were categorized into six groups: preterm controls with and without brain injury, clinical infection, culture positive infection, NEC diagnosis with and without sepsis. A generalized linear model was used to assess the change in NAA/choline from scan 1 to scan 2 across groups (divided by the difference between ages at scan), adjusted for gestational age at birth and site. Post-hoc between-group comparisons were Bonferroni corrected (P<0.05). RESULTS: The groups were composed of the following number of infants: 51 with brain injury, 31 without brain injury, 28 had clinical infection, 61 had sepsis, 17 had NEC without sepsis and 25 had NEC with sepsis. The change in NAA/choline from scan 1 to 2 was significantly different between groups (P=0.04). Post-hoc comparisons revealed the rate of NAA/choline change was significantly lower in infants with NEC and concurrent sepsis in comparison to controls without injury (P=0.01). CONCLUSIONS: Infants with NEC and additional sepsis are at high risk for adverse metabolic brain development. This work highlights the importance of the prevention of NEC and sepsis.