328 - Clinical determinants of intestinal failure and death in preterm infants with surgical necrotizing enterocolitis

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 328
Publication Number: 328.133

Parvesh Mohan Garg, Atrium Health Wake Forest Baptist, Winston Salem, NC, United States; Robin A. Riddick, University of Mississippi School of Medicine, Madison, MS, United States; McKenzie D. Ostrander, University of Mississippi School of Medicine, Jackson, MS, United States; Mitchell Ostrander, University of Mississippi School of Medicine, Jackson, MS, United States; Padma Garg, University of Mississippi School of Medicine, Madison, MS, United States; William B. Hillegass, University of Mississippi Medical Center, Jackson, MS, United States

Presenting Author(s)

Parvesh Mohan Garg, MD (he/him/his)

Associate Professor
Atrium Health Wake Forest Baptist
Winston Salem, North Carolina, United States

Background:

The clinical predictors of combined outcomes of death and intestinal failure in preterm infants with surgical necrotizing enterocolitis (NEC) are not well studied.

Objective:

We sought to investigate the clinical determinants of intestinal failure and death in preterm infants with surgical NEC.

Design/Methods:

Retrospective comparison of clinical information between Group A = intestinal failure (Parenteral nutrition (PN) >90days) and death and Group B = survivors and with PN dependence < 90 days in preterm infants with surgical NEC. Associations between clinical factors and outcomes were assessed with univariate and multivariable logistic regression analyses.

Results:

143 infants were included in the analysis. Group A (n= 99/143) had lower mean gestational age (26.4 weeks [SD3.5] vs 29.4 [SD 3.5]; p=0.013), lower mean birth weight (873gm [SD 427g] vs. 1425 gm [894g]; p=< 0.001), later age of NEC onset 22 days [ SD20] vs. 16 days [ SD 17];p=0.128], received surgery later (276 hours[SD 544] vs 117 hours[SD 267];p= 0.032), had cholestasis (77% vs 44% ;p=0.003), received invasive ventilation ( 95% vs 78% ;p=0.004) and dopamine ( 80.6% vs 58.5% ;p=0.010)more frequently than Group B infants. Those in Group A had significantly higher mean WBC count, lower mean lymphocyte percentages, and higher absolute monocyte counts than Group B. There was no significant difference in necrosis, inflammation, hemorrhage and the reparative changes on intestinal pathology, white matter injury, and surgical complications in the two groups.

Group A infants had significantly longer postoperative ileus time 19.8 days [SD 15.4] vs. 11.8 [SD 6.5]; p=< 0.001) and took time to reach full feeds 93 days [SD 45] vs. 44 days [SD 22]; p=< 0.001) than Group B.

On multivariate logistic regression, higher birth weight was associated with lower risk (OR 0.35, 95% CI 0.15- 0.82; p= 0.016) of TPN >90days or death. Longer length of bowel resected (OR 1.76, 95% CI 1.02-3.02; p=0.039) and longer postoperative ileus days (OR 2.87, 95% CI 1.26- 6.53; p=0.011) were independently associated with TPN >90days or death.

Conclusion(s):

In preterm infants with surgical NEC, clinical factors such as a higher birth weight (lower risk), longer bowel loss and postoperative ileus days were more likely associated with TPN >90days or death.