Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) affect 6–8% of extremely low birth weight (ELBW) infants. SIP has lower mortality than NEC, but with similar short-term morbidity in length of stay, growth failure, and supplemental oxygen requirements. Comparative long-term neurodevelopmental outcomes have not been clarified. Data were prospectively collected from 59 North American neonatal units, regarding ELBW infants (401–1000 g or 22–27 weeks gestational age) born between 2011 and 2018 and evaluated again at 16–26 months corrected age. Outcomes were collected from infants with laparotomy-confirmed NEC, laparotomy-confirmed SIP, and those without NEC or SIP. The primary outcome was severe neurodevelopmental disability. Secondary outcomes were weight <10th percentile, medical readmission, post-discharge surgery and medical support at home. Adjusted risk ratios (ARR) were calculated. Of 13,673 ELBW infants, 6391 (47%) were followed including 93 of 232 (40%) with NEC and 100 of 235 (42%) with SIP. There were no statistically significant differences in adjusted risk of any outcomes when directly comparing NEC to SIP (ARR 2.35; 95% CI 0.89, 6.26). However, infants with NEC had greater risk of severe neurodevelopmental disability (ARR 1.43; 1.09–1.86), rehospitalization (ARR 1.46; 1.17–1.82), and post-discharge surgery (ARR 1.82; 1.48–2.23) compared to infants without NEC or SIP. Infants with SIP only had greater risk of post-discharge surgery (ARR 1.64; 1.34–2.00) compared to infants without NEC or SIP. ELBW infants with NEC had significantly increased risk of severe neurodevelopmental disability and post-discharge healthcare needs, consistent with prior literature. We now know infants with SIP also have increased healthcare needs. Level II.

中文翻译：

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比较极低出生体重婴儿与 NEC 和自发性肠穿孔的医疗需求

坏死性小肠结肠炎 (NEC) 和自发性肠穿孔 (SIP) 影响 6-8% 的极低出生体重 (ELBW) 婴儿。 SIP 的死亡率低于 NEC，但在住院时间、生长障碍和补充氧气需求方面的短期发病率相似。比较长期神经发育结果尚未明确。数据前瞻性地从 59 个北美新生儿单位收集，涉及 2011 年至 2018 年间出生的 ELBW 婴儿（401-1000 克或 22-27 周胎龄），并在 16-26 个月的校正年龄时再次进行评估。结果收集自剖腹手术确诊的 NEC、剖腹手术确诊的 SIP 以及无 NEC 或 SIP 的婴儿。主要结局是严重的神经发育障碍。次要结局是体重<第 10 个百分位、再入院、出院后手术和家庭医疗支持。计算调整后的风险比（ARR）。在 13,673 名 ELBW 婴儿中，对 6391 名 (47%) 进行了随访，其中 232 名中的 93 名 (40%) 患有 NEC，235 名中的 100 名 (42%) 患有 SIP。直接比较 NEC 与 SIP 时，任何结果的调整风险均无统计学显着差异（ARR 2.35；95% CI 0.89，6.26）。然而，与没有 NEC 或 NEC 的婴儿相比，患有 NEC 的婴儿出现严重神经发育障碍（ARR 1.43；1.09-1.86）、再住院（ARR 1.46；1.17-1.82）和出院后手术（ARR 1.82；1.48-2.23）的风险更大。啜。与没有 NEC 或 SIP 的婴儿相比，仅患有 SIP 的婴儿出院后手术的风险更大（ARR 1.64；1.34-2.00）。患有 NEC 的 ELBW 婴儿严重神经发育障碍和出院后医疗保健需求的风险显着增加，这与之前的文献一致。我们现在知道患有 SIP 的婴儿也有更高的医疗保健需求。二级。