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Neurodevelopmental impairment in necrotising enterocolitis survivors: systematic review and meta-analysis
  1. Andreea Matei1,
  2. Louise Montalva1,
  3. Alexa Goodbaum2,
  4. Giuseppe Lauriti3,4,
  5. Augusto Zani1
  1. 1 Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Division of General and Thoracic Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3 Department of Pediatric Surgery, Spirito Santo Hospital, Pescara, Italy
  4. 4 G. d’Annunzio University, Chieti-Pescara, Italy
  1. Correspondence to Professor Augusto Zani, Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, M5G 1X8, Canada; augusto.zani{at}


Aim To determine (1) the incidence of neurodevelopmental impairment (NDI) in necrotising enterocolitis (NEC), (2) the impact of NEC severity on NDI in these babies and (3) the cerebral lesions found in babies with NEC.

Methods Systematic review: three independent investigators searched for studies reporting infants with NDI and a history of NEC (PubMed, Medline, Cochrane Collaboration, Scopus). Meta-analysis: using RevMan V.5.3, we compared NDI incidence and type of cerebral lesions between NEC infants versus preterm infants and infants with medical vs surgical NEC.

Results Of 10 674 abstracts screened, 203 full-text articles were examined. In 31 studies (n=2403 infants with NEC), NDI incidence was 40% (IQR 28%–64%) and was higher in infants with surgically treated NEC (43%) compared with medically managed NEC (27%, p<0.00001). The most common NDI in NEC was cerebral palsy (18%). Cerebral lesions: intraventricular haemorrhage (IVH) was more common in NEC babies (26%) compared with preterm infants (18%; p<0.0001). There was no difference in IVH incidence between infants with surgical NEC (25%) and those treated medically (20%; p=0.4). The incidence of periventricular leukomalacia (PVL) was significantly increased in infants with NEC (11%) compared with preterm infants (5%; p<0.00001).

Conclusions This study shows that a large proportion of NEC survivors has NDI. NEC babies are at higher risk of developing IVH and/or PVL than babies with prematurity alone. The degree of NDI seems to correlate to the severity of gut damage, with a worse status in infants with surgical NEC compared with those with medical NEC.

Trial registration number CRD42019120522.

  • brain
  • ADHD
  • neonate
  • inflammation
  • neurodevelopmental impairment

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  • AM and LM contributed equally.

  • Correction notice This paper has been corrected since it was published online. The affiliation for author

    Giuseppe Lauriti has been updated.

  • Contributors Study conception and design: AZ, AM, LM. Data acquisition: AM, AG, LM. Analysis and data interpretation: AZ, LM, GL. Drafting of the manuscript: AZ, LM, AM. Critical revision: AZ, GL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.