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.
