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Surgery and the tiny baby: sensorineural outcome at 5 years of age. The Victorian Infant Collaborative Study Group
Insights
Surgery requiring general anesthesia in extremely preterm or extremely low birthweight infants is associated with poorer long-term sensorineural outcomes. This study highlights a significant link between surgical intervention and developmental disabilities in these vulnerable children.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Developmental Pediatrics
Background:
- Extremely preterm (<27 weeks gestational age) and extremely low birthweight (ELBW <1000g) infants face significant health challenges.
- Surgical interventions under general anesthesia are sometimes necessary during the primary hospitalization for these vulnerable infants.
- The long-term neurodevelopmental impact of such surgeries is not fully understood.
Purpose of the Study:
- To investigate the association between surgical procedures requiring general anesthesia during initial hospitalization and sensorineural outcomes at 5 years or older.
- To assess the rate of sensorineural disability in extremely preterm or ELBW survivors who underwent surgery compared to those who did not.
Main Methods:
- A cohort study was conducted in Victoria, Australia, involving survivors born between 1985 and 1987 with gestational age <27 weeks or birthweight <1000g.
- Sensorineural disability was assessed at 5 years or older in children who had undergone surgery requiring general anesthesia during their primary hospital stay.
- Statistical analysis compared sensorineural outcomes between surgically treated and non-surgically treated groups.
Main Results:
- Of 221 survivors assessed at 5 years, 54 (24.4%) required surgery under general anesthesia (e.g., ductus arteriosus ligation, hernia repair, CNS surgery).
- Among 53 surgically treated children assessed at 5+ years, 30.3% had severe, moderate, or mild sensorineural disabilities.
- The overall rate of sensorineural disability was significantly higher in children who underwent surgery compared to those who did not (P<0.001).
Conclusions:
- There is an adverse association between undergoing surgery requiring general anesthesia and long-term sensorineural outcomes in extremely preterm and ELBW infants.
- The findings underscore the importance of considering potential neurodevelopmental risks associated with surgical interventions in this high-risk population.
- Further research may explore strategies to mitigate these risks and optimize long-term outcomes for these infants.
Objective:
To determine whether an association exists between long-term sensorineural outcome and the need for surgery requiring general anaesthesia during the primary hospitalization in extremely preterm (<27 weeks of gestational age) or extremely low birthweight (ELBW birthweight <100Og) infants.
Methodology:
A geographically determined cohort study of extremely preterm or ELBW children in the State of Victoria, Australia. The study subjects were consecutive survivors with either gestational ages <27 weeks or birthweights <10OOg born in the State of Victoria during 3 years from 1 January 1985. The main outcome measure was the rate of sensorineural disability at 5 or more years of age in relation to surgical procedures requiring general anaesthesia performed during the primary hospitalization.
Results:
Of 221 children surviving to 5 years of age, 54 (24.4%) had at least one surgical operation requiring general anaesthesia during their primary hospitalization. The operations included the following: (i) ligation of ductus arteriosus (n = 26); (ii) inguinal hernia repair (n = 16); (iii) central nervous system surgery (n = 4); (iv) gastrointestinal surgery (n = 5); and (v) tracheostomy or bronchoscopy (n = 5). Of the 221 survivors to 5 years of age, 218 (98.6%) were assessed for sensorineural impairments and disabilities. Of the 53 children who were assessed at 5 or more years of age and who had had surgery, 7 (13.2%) were severely disabled, 8 (15.1%) were moderately disabled, 12 (22.6%) were mildly disabled,and 26 (49.1%) were non-disabled. The overall rate of sensorineural disability was significantly higher in children who had been operated on compared with those who had not (Mann-Whitney U-test, z =3.7, P<0.001).
Conclusions:
There is an adverse association between the need for surgery requiring general anaesthesia during the primary hospitalization and sensorineural outcome in extremely preterm or ELBW infants.