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Complex trajectories are associated with neurological impairment in infants with congenital gastrointestinal
Manon Midavaine1, Nicolas Vinit2, Victor Sartorius1,3
1Department of Neonatology, Necker-Enfants Malades University Hospital, APHP, Paris, France.
Insights
Nine percent of infants with congenital gastrointestinal malformations experience developmental delay by age two. Prolonged neonatal intensive care and hospitalizations increase this risk, while breastfeeding may offer protection.
Area of Science:
- Pediatric Surgery
- Neonatology
- Developmental Pediatrics
Background:
- Congenital gastrointestinal malformations require surgical intervention and can impact infant development.
- Neurodevelopmental outcomes in this population require further investigation.
Purpose of the Study:
- To describe the neurodevelopmental status of infants with congenital gastrointestinal malformations at two years of age.
- To identify factors associated with developmental delay in this cohort.
Main Methods:
- Retrospective cohort study of 118 infants undergoing surgery for gastrointestinal malformations.
- Neurodevelopment assessed at 24 months using the Ages and Stages Questionnaire (ASQ).
- Developmental delay defined as a total ASQ score ≤185.
Main Results:
- Nine percent (11/118) of infants exhibited developmental delay (ASQ ≤185).
- Factors associated with delay included earlier gestational age, longer invasive ventilation, and prolonged parenteral nutrition.
- Increased hospitalizations and longer neonatal intensive care unit (NICU) stays were significantly linked to developmental delay.
Conclusions:
- A significant proportion of infants with gastrointestinal malformations present with developmental delay at two years.
- Extended NICU stays and multiple hospitalizations are risk factors for neurodevelopmental disorders.
- Breastfeeding may confer a protective effect on neurodevelopmental outcomes.
Aim:
Our aims were to describe the neurodevelopment of infants with congenital gastrointestinal malformations at 2 years of age and to investigate the association between developmental delay and complex trajectories.
Methods:
We conducted a retrospective cohort study. Infants operated on for oesophageal atresia, abdominal wall defects, intestinal malformation, congenital diaphragmatic hernia and anorectal malformation were analysed. Neurodevelopment was assessed using the Ages and Stages Questionnaire at 24 months. The primary outcome was the presence of developmental delay, defined as ASQ-24 months of total score ≤ 185.
Results:
Of 118 patients, 11 (9%) had an ASQ-24 months ≤185. Factors associated with an ASQ-24 months ≤185 were earlier gestational age (p = 0.045), longer invasive ventilation (p = 0.046), longer parenteral nutrition (p = 0.043) and ≥2 hospitalisations in the first 2 years (p = 0.022). They had a significantly longer stay in the neonatal intensive care unit and subsequent hospitalisations (p = 0.007). After adjustment for prematurity and breastfeeding, this association remained statistically significant.
Conclusion:
Nine per cent of children with a gastrointestinal malformation show a developmental delay at the age of two. A prolonged stay in the neonatal intensive care unit and subsequent hospitalisations are associated with an increased risk of neurodevelopmental disorders, while breastfeeding may have a protective effect.
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