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Published on: November 20, 2015
Major Surgery, Brain Injury, and Neurodevelopmental Outcomes in Very Preterm Infants
Thiviya Selvanathan1, Stephanie H Au-Young1, Ting Guo1
1From the Department of Pediatrics (T.S., S.H.A.-Y., T.G., V.C., L.L., E.N.K., S.P.M.), The Hospital for Sick Children and University of Toronto, Ontario; Department of Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and Medical Imaging, University of Toronto, Ontario; Neonatology (E.N.K.), Mount Sinai Hospital, Toronto, Ontario; and Department of Pediatrics (A.S., R.E.G., S.P.M.), BC Women's & Children's Hospitals and University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Major surgery increases brain injury risk and harms neurodevelopment in very preterm infants. Infants needing surgery and experiencing brain injury had the poorest motor outcomes.
Area of Science:
- Neonatal neuroscience
- Pediatric surgery outcomes
- Developmental pediatrics
Background:
- Major surgery in very preterm infants poses risks to neurodevelopment.
- Brain injury is a known complication in this vulnerable population.
- Understanding the interplay between surgery, brain injury, and neurodevelopment is crucial.
Purpose of the Study:
- To investigate the association between major surgery and brain injury in very preterm infants.
- To determine if major surgery impacts neurodevelopmental outcomes.
- To examine if brain injury modifies the relationship between major surgery and neurodevelopment.
Main Methods:
- Prospective enrollment of very preterm infants across three neonatal intensive care units.
- Magnetic resonance imaging (MRI) used to assess moderate-to-severe brain injury.
- Bayley Scales of Infant and Toddler Development, third edition, used for 18-month neurodevelopmental assessment.
Main Results:
- Major surgery was significantly associated with an increased risk of brain injury (OR 2.54, p=0.03).
- Infants undergoing major surgery showed poorer motor outcomes (β = -7.92, p<0.001).
- A significant interaction between brain injury and major surgery predicted lower motor scores (p=0.04).
Conclusions:
- Very preterm infants requiring major surgery face higher risks of brain injury and adverse motor development.
- Major surgery may serve as an indicator of underlying clinical illness severity.
- Routine brain MRI and vigilant neurodevelopmental monitoring are recommended for these infants.
Objectives:
We determined whether (1) major surgery is associated with an increased risk for brain injury and adverse neurodevelopment and (2) brain injury modifies associations between major surgery and neurodevelopment in very preterm infants.
Methods:
Prospectively enrolled infants across 3 tertiary neonatal intensive care units underwent early-life and/or term-equivalent age MRI to detect moderate-severe brain injury. Eighteen-month neurodevelopmental outcomes were assessed with Bayley Scales of Infant and Toddler Development, third edition. Multivariable logistic and linear regressions were used to determine associations of major surgery with brain injury and neurodevelopment, adjusting for clinical confounders.
Results:
There were 294 infants in this study. Major surgery was associated with brain injury (odds ratio 2.54, 95% CI 1.12-5.75, p = 0.03) and poorer motor outcomes (β = -7.92, 95% CI -12.21 to -3.64, p < 0.001), adjusting for clinical confounders. Brain injury x major surgery interaction significantly predicted motor scores (p = 0.04): Lowest motor scores were in infants who required major surgery and had brain injury.
Discussion:
There is an increased risk for brain injury and adverse motor outcomes in very preterm infants who require major surgery, which may be a marker of clinical illness severity. Routine brain MRI to detect brain injury and close neurodevelopmental surveillance should be considered in this subgroup of infants.
