Prior studies have noted that preterm infants who develop necrotizing enterocolitis (NEC) have worse neurodevelopmental outcomes (references 1-3 in the Howarth study). The mechanism for this worse neurodevelopmental outcome is not known. Howarth et al (10.1542/peds.2020-0337) evaluated whether changes in cerebral oxygenation were occurring in the setting of this intestinal injury. The authors share with us a longitudinal look at 48 infants <30 weeks’ gestation at birth some of whom developed NEC. All infants received weekly near infrared spectroscopy (NIRS) monitoring to measure cerebral oxygenation until infants were 36 weeks post conception in age. The authors found that in the 6 infants with NEC consistently had lower cerebral oxygenation even when adjusting for gestational age, birthweight, presence of a patent ductus arteriosus, enteral feeds, sex, race/ethnicity, and hemoglobin suggesting that those with NEC have lower cerebral oxygenation compared to those without. They conclude that this unique finding might be a key reason for the worsened developmental delay in preterm infants with NEC.
Why is this finding important? We asked Dr. Rosemary Horne from Monash University in Melbourne Australia to share her thoughts in an accompanying commentary (10.1542/peds.2020-014407). She helps us understand the role that a decrease in cerebral oxygenation can play in neurodevelopmental outcomes in preterm infants, the important role that NIRS serves in helping us now monitor this type of oxygenation, and what trials are going on now to reduce or remedy such decreases if detected or associated with an insult such as NEC. She also notes the importance of being able to follow these infants longitudinally to see if their level of development is affected long-term by the differences in cerebral oxygenation noted for the 6+ weeks they were monitored using NIRS. Even if you are not a neonatologist, this study and commentary will bring you up to speed on a fascinating way to gain insight into the neurodevelopmental abnormalities we may see in preterms, how cerebral oxygenation may be playing a role, and what the future holds for improving cerebral oxygenation during the NICU stay. Link to both study and commentary and learn more.