325 - Necrotizing Enterocolitis and Bronchopulmonary Dysplasia: Is There a Relationship?

Publication Number: 4319.325

Tian Mauer, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States; Vera Ignjatovic, Johns Hopkins All Children's Hospital Institute for Clinical and Translational Research, St. Petersburg, FL, United States; Abigail Winston, Brigham and Women's Hospital, Boulder, CO, United States; Yvonne YG. Sheldon, MGB, New London, NH, United States; John M. Morrison, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Linda J. Van Marter, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States

Background: Bronchopulmonary Dysplasia (BPD) and Necrotizing Enterocolitis (NEC) are 2 of the most common pathologies affecting preterm neonates. NEC typically occurs early in a preterm infant's course, while BPD is diagnosed later, at 36 weeks postmenstrual age. The inflammatory cascade caused by NEC may lead to a systemic response affecting other organs. Our study explored the relationship between NEC, BPD, and related clinical factors.

Objective: The primary objective evaluated the association of NEC as a predisposing risk factor for the development of BPD in infants born < 29 weeks of gestation. A secondary objective was to determine if early- or late-onset sepsis was an independent risk factor for BPD or modified the association between NEC and BPD.

Design/Methods: This was a single-center retrospective study of 1525 infants born at < 29 weeks of gestation at Brigham and Women's Hospital from 1997 to 2020(1). Our primary predictor was NEC, defined using Modified Bell staging criteria and dichotomized as none/Stage I (suspected NEC) or Stage II/Stage III (definite and advanced NEC)(2). Our primary outcome was the absence or stage of BPD using the 2019 Jensen Criteria (3). Sepsis was defined as culture-proven or clinical, and classified as early-onset ( < 4 days of life) or late-onset (≥4 days), each treated with ≥5 days of antibiotic therapy. Small for gestational age (SGA) was defined by the Fenton criteria. Statistical analysis was performed using Chi-squared and Fisher's Exact tests for categorical variables, and linear regression and nonparametric tests were applied to continuous variables. Multivariate analysis was performed with logistic regression.

Results: Stage II/III NEC was significantly associated with BPD Grades 2 and 3. Of those who developed BPD Grade 2, 12% had Stage II NEC and 6% had Stage III NEC. 25% of infants with BPD Grade 3 had Stage III NEC. In the multivariate model, additional covariates significantly associated with increased odds of BPD Grade 2 or 3 were: NEC Stage II/III (adjusted odds ratio [aOR] 2.05), SGA (aOR 3.52), PDA (surgical treatment) (aOR 2.42), recipient of dexamethasone (aOR 3.04), clinical late sepsis (aOR 1.58), and non-Caucasian race (aOR 1.69). Variables significantly decreasing the odds of BPD Grades 2 or 3 included female sex (aOR 1.69) and gestational age ≥ 27 weeks (aOR 0.50).

Conclusion(s): This single-center study found that preterm neonates with NEC Stages II and III were more likely to develop BPD Grades 2 or 3. More severe NEC was associated with an increased risk of developing moderate or severe BPD.

NEC and BPD Results Table 1


NEC and BPD Results Table 2


Abstract References