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Early surgery and neurodevelopmental outcomes of children born extremely preterm
Rodney W Hunt1,2,3,4, Leah M Hickey1, Alice C Burnett1,3,4,5
1Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia.
Insights
Children born extremely preterm (EP) who had surgery in the newborn period had significantly higher rates of major neurosensory disability at 8 years. These disability rates in the surgical group have not improved over time.
Area of Science:
- Neonatal care
- Pediatric neurodevelopment
- Surgical outcomes
Background:
- Extremely preterm (EP) infants often require surgical interventions during their initial hospital stay.
- Neurodevelopmental outcomes at 8 years for EP infants who underwent surgery are not well-established.
- Previous studies have not consistently compared outcomes based on surgical status in EP infants.
Purpose of the Study:
- To compare neurodevelopmental outcomes at 8 years in extremely preterm (EP) infants who had surgery versus those who did not.
- To examine neurodevelopmental outcomes across different eras (1991-2005) in EP infants.
- To identify potential risk factors for major neurosensory disability in EP infants.
Main Methods:
- Prospective observational cohort studies across three eras (1991-1992, 1997, 2005).
- Assessment of surviving EP children at 8 years for general intelligence (IQ) and neurosensory status.
- Definition of major neurosensory disability included cerebral palsy, low IQ, blindness, or deafness.
Main Results:
- 29% of EP survivors underwent surgery during the newborn period, with consistent rates across eras.
- Major neurosensory disability was significantly higher in the surgical group (33%) compared to the non-surgical group (10%).
- Rates of disability in the surgical cohort did not improve over time; no specific surgery was linked to increased risk.
Conclusions:
- Surgical procedures during initial hospitalization are associated with increased major neurosensory disability in extremely preterm infants at 8 years.
- The lack of improvement in outcomes for the surgical group over time highlights a critical area for intervention.
- Further research is needed to understand the mechanisms linking neonatal surgery to long-term neurodevelopmental deficits in EP infants.
Objectives:
To (1) compare the neurodevelopmental outcomes at 8 years of age of children born extremely preterm (EP) who underwent surgical procedures during the course of their initial hospital admission with those who did not and (2) compare the outcomes across eras, from 1991 to 2005.
Design:
Prospective observational cohort studies conducted over three different eras (1991-1992, 1997 and 2005). Surviving EP children, who required surgical intervention during the primary hospitalisation, were assessed for general intelligence (IQ) and neurosensory status at 8 years of age. Major neurosensory disability comprised any of moderate/severe cerebral palsy, IQ less than -2 SD relative to term controls, blindness or deafness.
Results:
Overall, 29% (161/546) of survivors had surgery during the newborn period, with similar rates in each era. Follow-up rates at 8 years were high (91%; 499/546), and 17% (86/499) of survivors assessed had a major neurosensory disability. Rates of major neurosensory disability were substantially higher in the surgical group (33%; 52/158) compared with those who did not have surgery (10%; 34/341) (OR 4.28, 95% CI 2.61 to 7.03). Rates of disability in the surgical group did not improve over time. After adjustment for relevant confounders, no specific surgical procedure was associated with increased risk of disability.
Implications And Relevance:
Major neurosensory disability at 8 years was higher in children born EP who underwent surgery during their initial hospital admission compared with those who did not. The rates of major neurosensory disability in the surgical cohort are not improving over time.
