Journal article
Surgery and Neurodevelopmental Outcome of Very Low Birth Weight Infants
JAMA pediatrics, Vol.168(8), pp.746-754
08/01/2014
DOI: 10.1001/jamapediatrics.2014.307
PMCID: PMC4142429
PMID: 24934607
Abstract
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.
Details
- Title: Subtitle
- Surgery and Neurodevelopmental Outcome of Very Low Birth Weight Infants
- Creators
- Frank H Morriss Jr - Department of Pediatrics, University of Iowa, Iowa City, IAShampa Saha - Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NCEdward F Bell - Department of Pediatrics, University of Iowa, Iowa City, IATarah T Colaizy - Department of Pediatrics, University of Iowa, Iowa City, IABarbara J Stoll - Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GASusan R Hintz - Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CASeetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, MIBetty R Vohr - Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, RIShannon E. G Hamrick - Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GAAthina Pappas - Department of Pediatrics, Wayne State University, Detroit, MIPatrick M Jones - Department of Pediatrics, University of Texas Medical School at Houston, Houston, TXWaldemar A Carlo - Division of Neonatology, University of Alabama at Birmingham, Birmingham, ALAbbot R Laptook - Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, RIKrisa P Van Meurs - Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CAPablo J Sánchez - Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; now The Ohio State University, Columbus, OHEllen C Hale - Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GANancy S Newman - Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OHAbhik Das - Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MDRosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MDEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- JAMA pediatrics, Vol.168(8), pp.746-754
- DOI
- 10.1001/jamapediatrics.2014.307
- PMID
- 24934607
- PMCID
- PMC4142429
- NLM abbreviation
- JAMA Pediatr
- ISSN
- 2168-6203
- eISSN
- 2168-6211
- Language
- English
- Date published
- 08/01/2014
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984093508402771
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