Cytokine levels in neonatal necrotizing enterocolitis and long‐term growth and neurodevelopment

Objective: To investigate if circulating cytokines are related to growth and neurodevelopmental outcome following necrotizing enterocolitis (NEC). Study design: Pro‐inflammatory cytokine levels were measured prospectively in 40 neonates and compared with neurodevelopmental outcome. Cytokine levels were measured at the onset of feeding intolerance (Group II, n = 17) or NEC (Group III, n = 10) and at weeks 2–3 in control infants (Group I, n = 13). Neurodevelopmental outcome was assessed at the age of 24–28 months. Data were analysed using descriptive statistics, non‐parametric tests and Student t‐test. Results: Median birth weights (range) in groups I, II and III were 1120 (525–1564) g, 1068 (650–1937) g and 1145 (670–2833) g, and median gestational ages (range) were 28 (24–35) weeks 28 (24–35) weeks and 28 (25–37) weeks respectively. NEC occurred in 10 infants. Serum IL‐6 (interleukin‐6) was elevated in group III, (p = 0.03). Significant developmental delay was found in 12% of the infants in Group II and 20% of the infants in Group III, but no infant in group I. Five infants in group III with NEC (50%), had head ultrasound abnormalities. At 1 year of age, growth, weight and head circumference were significantly different in Group III, however, at two years of age, only height was significantly different, p < 0.02. Although there was wide variation, neonatal cytokine levels tended to be greater in the infants later found to have abnormal cognitive and psychomotor outcomes. Conclusion: This study suggests that increased serum levels of pro‐inflammatory cytokines may play a role in the poor growth and neurodevelopment associated with this high‐risk population.