Neurodevelopmental Outcomes and Growth in Infants With Congenital Gastrointestinal Anomalies Requiring Neonatal Surgery
Neurodevelopmental Outcomes and Growth in Infants With Congenital Gastrointestinal Anomalies Requiring Neonatal Surgery
Infants with congenital gastrointestinal anomalies (CGIA) experience multiple physiologic
 stressors, including neonatal surgery, early in life during an essential time of growth and
 development. Early physiologic stressors such as inadequate nutrition have been linked to
 altered growth patterns and neurodevelopmental delays later in life. In other groups of
 at-risk infants, early body composition measurements can be used as predictors of long-term
 health outcomes more so than weight and length alone. The primary objective of this study is
 to determine if body composition changes in early life are predictive of neurodevelopmental
 outcomes among infants with CGIA. The secondary objective is to determine if infants with
 CGIA have altered body composition over time when compared with healthy infants. The
 investigators propose a prospective, observational study of infants with CGIA, including
 detailed chart review, body composition measurements, and neurodevelopmental testing at
 follow-up. If a correlation between body composition measurements and neurodevelopmental
 outcomes is established in this population, the addition of body composition measurement to
 standard of care in the neonatal intensive care unit and in follow-up care could allow for
 further optimization of overall health and development of this vulnerable pediatric
 population through earlier detection of growth alterations and informed interventions.
Infants with congenital gastrointestinal anomalies (CGIA) including gastroschisis,
 omphalocele, esophageal and bowel atresias, tracheoesophageal fistulas, Hirschsprung's
 disease, and congenital diaphragmatic hernias, account for ~7 in 10,000 live births. Early in
 life, these infants undergo major surgery under general anesthesia followed by a prolonged
 period of inadequate nutrition, exposure to post-operative pain medications and antibiotics,
 and parental separation. Despite exposure to these risk factors for future growth failure and
 neurodevelopmental delay, growth and neurodevelopmental outcomes have not been well described
 in this group of at-risk infants. Preliminary findings in preschool-age children with CGIA
 suggest that these children have slower speed of processing compared to healthy children and
 that increased fat-free mass (FFM) at preschool age is associated with higher cognitive test
 scores. However, no studies to date have described the longitudinal relationship between
 growth, body composition, nutrition, inflammation, and neurodevelopmental outcomes in infants
 with CGIA. To address this research gap, the investigators propose to conduct a prospective
 cohort study enrolling infants with CGIA to measure their growth and development over time.
 Infant growth and body composition will be measured at or near term and at 4 months corrected
 age.

 The investigators hypothesize that infants with CGIA will undergo a period of rapid catch-up
 growth early in life, and infants who demonstrate better catch-up growth will have better
 neurodevelopmental outcomes compared to infants that do not experience catch-up growth. At 4
 months corrected age, early neurologic outcomes will be measured using event related
 potentials (ERP). Clinical information including nutrient intake, inflammatory markers, and
 medications received will be gathered throughout the neonatal intensive care unit (NICU)
 hospitalization to assess the impact physiologic stressors have on changes in body
 composition and cognitive outcomes.

 The objective of this study is to determine the impact of early nutrition, inflammation,
 physiologic stress, growth, and body composition on later neurodevelopmental outcomes in
 infants requiring neonatal surgery for CGIA.

 Specific aims include:

 Aim 1. To determine if infants with CGIA requiring neonatal surgery have altered body
 composition growth patterns compared to healthy infants.

 Aim 1a. To determine if early physiologic stress and/or malnutrition are associated with
 altered body composition in infants with CGIA compared to healthy infants.

 Hypothesis: CGIA infants with increased early nutritional intake and decreased inflammation
 will have greater FFM gains and more appropriately mimic the growth of healthy comparison
 infants.

 Aim 2. To determine if FFM gains in infancy are associated with improved neurodevelopmental
 outcomes among infants with CGIA.

 Hypothesis: Greater FFM gains from birth to 4 months corrected age will be associated with
 faster speed of processing and better recognition memory among infants with CGIA.

 The investigators hypothesize that early exposure to physiologic stressors impact the
 framework of the developing brain leading to long-lasting changes in development and that FFM
 accretion is an important biomarker of long-term outcomes for this population. The
 investigators hope to discover methods to better identify those infants at risk for poor
 neurodevelopmental outcomes and provide improved recommendations regarding nutritional and
 educational interventions that will ensure these infants achieve their full potential. These
 findings could also be used to encourage local and national NICU follow-up programs to expand
 beyond the follow-up of preterm infants to include high-risk populations such as infants born
 with CGIA. In addition, this proposed study could greatly impact community population health
 by optimizing growth and neurodevelopmental outcomes in children previously hospitalized in
 NICUs.
Inclusion Criteria:

 -  Late preterm (at or above 35 weeks gestation) and term infants

 -  Admitted to the NICU

 -  Diagnosed with congenital gastrointestinal anomalies, defined as gastroschisis,
 omphalocele, esophageal and bowel atresias, tracheoesophageal fistulas, Hirschsprung's
 disease, or congenital diaphragmatic hernias.

 Exclusion Criteria:

 -  Infants born before 35 weeks gestation

 -  Infants with cardiac defects requiring intervention

 -  Infants with known chromosomal abnormalities that affect growth or cognition

 -  Infant born to families that are non-English speaking due to lack of interpreter
 services available