Children With Intestinal Failure, Necrotizing Enterocolitis at Risk for Adverse Cognitive Outcomes

Photo taken in Chiang Mai, Thailand
Investigators evaluated cognitive outcomes in children with intestinal failure (IF) and at risk for IF as a result of conditions that affect the small intestine.

Children with intestinal failure (IF) or at high risk for IF due to a condition affecting the small intestine are more likely to have impaired cognitive development compared with the general population, according to study results published in the Journal of Pediatric Gastroenterology and Nutrition.

For the study, researchers conducted a systematic review and meta-analysis, sourcing data from research on children with IF, surgical necrotizing enterocolitis (NEC), abdominal wall defects (AWD), or midgut malformations (MM). Of 30 total studies included, 26 were used for the meta-analysis to assess developmental quotient (DQ) and intelligence quotient (IQ); 21 studies were used in the meta-analysis to assess prevalence of severe developmental delay/disability (SDD). Additional factors, such as duration of parenteral nutrition therapy, were also analyzed.

Compared with the mean DQ/IQ in the general population (100±15), children with IF and NEC had the lowest DQ/IQ at 86.1 and 83.3, respectively. Adverse cognitive effects were less evident in children with MM or AWD, with DQ/IQ of 99.5 and 96.6, respectively. Duration of parenteral nutrition dependence did not correlate to a lower DQ/IQ.

SDD, defined as DQ/IQ less than 70, has a rate of 1.8% in the general population. Similar to DQ/IQ rates, children with IF and NEC had the most notable cognitive effects, with rates of SDD of 28.6 % and 32.8%, respectively. Rates of SDD in children with MM or AWD, while much lower than rates in IF or NEC, were still higher than the rate of SDD in the general population, at 3.7% and 8.5%, respectively.

Study limitations included an extensive heterogeneity between included studies. Additionally, there was minimal representation of MM, with only 2 studies on DQ/IQ and 1 study involving SDD.

“As survival rates of children with IF are improving, the number of at-risk patients is increasing,” the study authors noted. “Therefore, it is important to monitor cognitive development in this vulnerable patient population and explore avenues for prevention and remediation whenever possible.”


Vlug LE, Verloop MW, Dierckx B, et al. Cognitive outcomes in children with conditions affecting the small intestine: a systematic review and meta-analysis. J Pediatr Gastroenterol Nutr. 2022;74(3): 368-376. doi:10.1097/MPG.0000000000003368