Neonatal Intestinal Failure is Independently Associated With Impaired Cognitive Development Later in Childhood.

Abstract

OBJECTIVE The impact of pediatric intestinal failure (IF) on neurodevelopment beyond infancy has not been systematically studied. Our aim was to evaluate cognitive and motor impairment and to identify risk factors for adverse outcomes among children with IF. METHODS We conducted a cross-sectional single-center study at the Helsinki University Children's Hospital. IF patients with > 60 days of parental nutrition (PN) dependency aged between three and sixteen years (n = 40) were invited to participate. The cognitive and motor skills were evaluated using validated tests: Wechsler Preschool and Primary Scale of Intelligence, 3 edition, Wechsler Intelligence Scale for Children, 4 edition, and Movement Assessment Battery for Children, 2 edition. RESULTS All the patients attending the study tests (n = 30, males = 24) were included. Their median age, gestational age and birth weight was 7.5 (range 3 to 16) years, 35 (IQR 28-38) weeks and 2,238 (IQR 1,040-3,288) grams, respectively. Median duration of PN was 13 (IQR 5-37) months and 9 patients were currently on PN. Median Intelligence quotient (IQ) was 78 (IQR 65-91) and ten (35%) patients had an IQ under 70 (-2 SD). Significant motor impairment was detected in 10 patients (36%) and milder difficulties in 8 (28%). Adverse cognitive outcome was associated with neonatal short bowel syndrome, number of interventions under general anesthesia, and length of inpatient status, while adverse motor outcome was associated with prematurity. CONCLUSION Clinically significant cognitive and motor impairments are alarmingly common among neonatal IF patients. We recommend early neurodevelopmental follow-up for all children with IF.