Cognitive Outcomes in Children with Conditions Affecting the Small Intestine: A Systematic Review and Meta-analysis

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Objectives:The aim of the study was to assess cognitive outcomes in children with intestinal failure (IF) and children at high risk of IF with conditions affecting the small intestine requiring parenteral nutrition.Methods:EMBASE, Cochrane, Web of Science, Google Scholar, MEDLINE, and PsycINFO were searched from inception to October 2020. Studies were included constituting original data on developmental quotient (DQ), intelligence quotient (IQ) and/or severe developmental delay/disability (SDD) rates assessed with standardized tests. We used appropriate standardized tools to extract data and assess study quality. We performed random effects meta-analyses to estimate pooled means of DQ/IQ and pooled SDD rates (general population mean for DQ/IQ: 100, for percentage with SDD: 1.8%) for 4 groups: IF, surgical necrotizing enterocolitis (NEC), abdominal wall defects (AWD), and midgut malformations (MM). Associations of patient characteristics with DQ/IQ were evaluated with meta-regressions.Results:Thirty studies met the inclusion criteria. The pooled mean DQ/IQ for IF, NEC, AWD, and MM were 86.8, 83.3, 96.6, and 99.5, respectively. The pooled SDD rates for IF, NEC, AWD and MM were 28.6%, 32.8%, 8.5%, and 3.7%, respectively. Meta-regressions indicated that lower gestational age, longer hospital stay, and higher number of surgeries but not parenteral nutrition duration, were associated with lower DQ/IQ.Conclusions:Adverse developmental outcomes are common in children with IF and NEC, and to a much lesser extent in children with AWD and MM. It is important to monitor cognitive development in children with conditions affecting the small intestine and to explore avenues for prevention and remediation.

Original languageEnglish
Pages (from-to)368-376
Number of pages9
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number3
Publication statusPublished - 1 Mar 2022

Bibliographical note

Funding Information:
L.V.'s salary is supported by funding from the Stichting Vrienden van het Sophia (Erasmus MC Sophia Children's Hospital, ‘Sporten voor Sophia’ event).

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.


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