Presented at the Neonatal Society 2017 Spring Meeting.
Kong M, Lennartsson F, Darekar A, Hall N, Vollmer B
Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton
Neonatal and Paediatric Neurology, Southampton Children’s Hospital. Department of Medical Physics, University Hospital Southampton NHS Foundation Trust
University Surgery Unit, Faculty of Medicine, University of Southampton
Background: Necrotising Enterocolitis (NEC) is an inflammatory bowel disease causing intestinal gangrene, resulting in septicaemia. Infants born very preterm (<32 weeks of gestation; GA) are at high risk of developing NEC; around 50% of these infants require surgery (1). Surgically treated infants have 60% greater risk of neurodevelopmental impairment than other babies born at similar GA. Here, we explore the hypothesis that brain white matter development is impaired in preterm infants with NEC, which might explain poorer neurodevelopmental outcome in these infants.
Methods: This study included 8 preterm born infants (3 male, mean GA 27 weeks, SD=14.95 days) with confirmed NEC (Bell stage II/III), treated at a tertiary neonatal centre. Two control groups were recruited; a preterm control group without NEC (PTC; n=8, matched for at least two; GA +/- 2 weeks, birth weight Z-score, sex, and intraventricular haemorrhage), and a term control (TC) group of n=11 healthy term-born infants. Infants were scanned on a 1.5T MRI scanner at term equivalent age (37-44 weeks GA). Diffusion MRI data were acquired and Tract-Based Spatial Statistics (TBSS) adapted for newborns was used to compare fractional anisotropy (FA) in white-matter tracts on a whole-brain level between groups. Ethics approval: 12/SC/0487, NRES South Central – Portsmouth. Baily Thomas Charitable Fund (a noncommercial, NIHR portfolio approved charity).
Results: Correcting for post-menstrual age at scan, preliminary findings indicate that infants in the NEC and PTC groups have a significantly lower FA in central WM tracts compared to term-born infants (p<0.05 and p<0.05 respectively). Gestational age corrected comparisons found a weak trend of decreased FA in the splenium of the corpus callosum in NEC infants compared to preterm controls (p<0.12). At age 3 months, poorer motor development (Alberta Infant Motor Scale) and more atypical neurological signs (Hammersmith Infant Neurological Examination) are observed in the NEC group compared to the TC and PTC group.
Conclusion: These preliminary findings indicate microstructural white-matter changes associated with NEC, particularly in the corpus callosum. However, a larger sample is required for further confirmation. Thereafter, associations with neurodevelopmental outcome measures can be examined.
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1. Eaton S, Hall N, Rees C, Pierro A. Necrotising enterocolitis: Pathogenesis, medical management and surgery. British Journal of Intensive Care. 2004 Sep 1;14(3):101-5.