Neurologic Outcomes in Very Preterm Infants Undergoing Surgery

doi:10.1016/j.jpeds.2011.09.009

The Journal of Pediatrics

Volume 160, Issue 3, March 2012, Pages 409-414

https://doi.org/10.1016/j.jpeds.2011.09.009 Get rights and content

Objective

To investigate the relationship between surgery in very preterm infants and brain structure at term equivalent and 2-year neurodevelopmental outcome.

Study design

A total of 227 infants born at <30 weeks gestation or at a birth weight of <1250 g were prospectively enrolled into a longitudinal observational cohort for magnetic resonance imaging and developmental follow-up. The infants were categorized retrospectively into either a nonsurgical group (n = 178) or a surgical group (n = 30). Nineteen infants were excluded because of incomplete or unsuitable data. The surgical and nonsurgical groups were compared in terms of clinical demographic data, white matter injury, and brain volume at term. Neurodevelopmental outcome was assessed at age 2 years.

Results

Compared with the nonsurgical group, the infants in the surgical group were smaller and more growth-restricted at birth, received more respiratory support and oxygen therapy, and had longer hospital stays. They also had smaller brain volumes, particularly smaller deep nuclear gray matter volumes. Infants who underwent bowel surgery had greater white matter injury. Mental Developmental Index scores were lower in the surgical group, whereas Psychomotor Developmental Index scores did not differ between the groups. The Mental Developmental Index difference became nonsignificant after adjustment for confounding variables.

Conclusion

Preterm infants exposed to surgery and anesthesia had greater white matter injury and smaller total brain volumes, particularly smaller deep nuclear gray matter volumes. Surgical exposure in the preterm infant should alert the clinician to an increased risk for adverse cognitive outcome.

Section snippets

Methods

Preterm infants admitted to the neonatal units of the Royal Women’s Hospital and Royal Children’s Hospital, Melbourne, Australia, between April 2001 and January 2004 were prospectively recruited into an observational cohort magnetic resonance imaging (MRI) study, the Victorian Infant Brain Study. This study had the approval of the local hospitals’ Ethics Committees. Informed consent was obtained from parents. Infants born at either <30 weeks gestation or at a birth weight of <1250 g were

Results

A total of 227 infants (70% of all eligible infants) were recruited into the study. Eight of these infants had incomplete data and were eliminated; thus, 219 infants were included in the study. Forty-one infants (19%) had undergone at least 1 surgical procedure before being discharged from the neonatal unit. A total of 51 surgical procedures were performed on these 41 infants. These procedures included inguinal hernia repair (n = 22), bowel surgery for necrotizing enterocolitis or bowel

Discussion

Surgery was common in the very preterm infants of our cohort, with 19% of infants born at <30 weeks gestation or at a birth weight of <1250 g undergoing a surgical procedure requiring general anesthesia before discharge from the neonatal unit, and 7% of infants undergoing 2 or more procedures. Very preterm infants who undergo surgery while in neonatal intensive care are more likely to be growth-restricted at birth and experience greater neonatal respiratory morbidity. In addition, very preterm

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: The authors declare no conflicts of interest.

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Original ArticleNeurologic Outcomes in Very Preterm Infants Undergoing Surgery

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

Semin Fetal Neonatal Med

J Pediatr Surg

J Pediatr

Med Image Anal

J Pediatr Surg

Semin Perinatol

Outcome of extreme prematurity: as information increases, so do the dilemmas

Arch Dis Child Fetal Neonatal Ed

The Victorian Infant Collaborative Group. Surgery and the tiny baby: sensorineural outcome at 5 years of age

J Pediatr Child Health

Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms (TIPP)

J Pediatr

Original Article
Neurologic Outcomes in Very Preterm Infants Undergoing Surgery