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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Surgery and neurodevelopmental outcome of very low-birth-weight infants
Frank H Morriss1, Shampa Saha2, Edward F Bell1
1Department of Pediatrics, University of Iowa, Iowa City.
Insights
Major surgery in very low-birth-weight infants significantly increases the risk of death or neurodevelopmental impairment. Minor surgery showed no increased risk, suggesting anesthesia type may play a role.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Developmental Pediatrics
Background:
- Reducing mortality and neurodevelopmental impairment in infants is a key goal in perinatal medicine.
- Very low-birth-weight (VLBW) infants are a vulnerable population requiring specialized care.
- The impact of surgical interventions during initial hospitalization on long-term outcomes for VLBW infants requires further investigation.
Purpose of the Study:
- To evaluate the association between undergoing surgery during initial hospitalization and the risk of death or neurodevelopmental impairment in VLBW infants.
- To differentiate the outcomes based on the type of surgery (major vs. minor) and anesthesia used.
- To assess the impact of major surgery on neurodevelopmental outcomes among survivors.
Main Methods:
- Retrospective cohort analysis of 12,111 VLBW infants (401-1500g) from the NICHD Neonatal Research Network Generic Database (1998-2009).
- Infants were assessed at 18-22 months' corrected age.
- Surgical procedures were categorized as major (general anesthesia) or minor (nongeneral anesthesia); outcomes included death or neurodevelopmental impairment, and neurodevelopmental impairment among survivors.
Main Results:
- A total of 2,186 infants had major surgery, 784 had minor surgery, and 9,141 had no surgery.
- Major surgery was associated with a 52% increased risk of death or neurodevelopmental impairment (aOR, 1.52; 95% CI, 1.24-1.87) compared to no surgery.
- Minor surgery did not show an increased adjusted risk; however, survivors of major surgery had higher rates of neurodevelopmental impairment and lower Bayley scores.
Conclusions:
- Major surgery in VLBW infants is independently linked to a significantly increased risk of death and neurodevelopmental impairment.
- The findings suggest a potential role for general anesthesia in adverse outcomes, though it remains unproven.
- These results highlight the importance of careful consideration of surgical timing and approach in VLBW infants.
Importance:
Reduced death and neurodevelopmental impairment among infants is a goal of perinatal medicine.
Objective:
To assess the association between surgery during the initial hospitalization and death or neurodevelopmental impairment of very low-birth-weight infants.
Design, Setting, And Participants:
A retrospective cohort analysis was conducted of patients enrolled in the National Institute of Child Health and Human Development Neonatal Research Network Generic Database from 1998 through 2009 and evaluated at 18 to 22 months' corrected age. Twenty-two academic neonatal intensive care units participated. Inclusion criteria were birth weight 401 to 1500 g, survival to 12 hours, and availability for follow-up. A total of 12 111 infants were included in analyses.
Exposures:
Surgical procedures; surgery also was classified by expected anesthesia type as major (general anesthesia) or minor (nongeneral anesthesia).
Main Outcomes And Measures:
Multivariable logistic regression analyses planned a priori were performed for the primary outcome of death or neurodevelopmental impairment and for the secondary outcome of neurodevelopmental impairment among survivors. Multivariable linear regression analyses were performed as planned for the adjusted mean scores of the Mental Developmental Index and Psychomotor Developmental Index of the Bayley Scales of Infant Development, Second Edition, for patients born before 2006.
Results:
A total of 2186 infants underwent major surgery, 784 had minor surgery, and 9141 infants did not undergo surgery. The risk-adjusted odds ratio of death or neurodevelopmental impairment for all surgery patients compared with those who had no surgery was 1.29 (95% CI, 1.08-1.55). For patients who had major surgery compared with those who had no surgery, the risk-adjusted odds ratio of death or neurodevelopmental impairment was 1.52 (95% CI, 1.24-1.87). Patients classified as having minor surgery had no increased adjusted risk. Among survivors who had major surgery compared with those who had no surgery, the adjusted risk of neurodevelopmental impairment was greater and the adjusted mean Bayley scores were lower.
Conclusions And Relevance:
Major surgery in very low-birth-weight infants is independently associated with a greater than 50% increased risk of death or neurodevelopmental impairment and of neurodevelopmental impairment at 18 to 22 months' corrected age. The role of general anesthesia is implicated but remains unproven.
