Margaret M Moran1, Julia K Gunn-Charlton2, Jennifer M Walsh3, Jeanie L Y Cheong4, Peter J Anderson5, Lex W Doyle6, Susan Greaves7, Rod W Hunt8. 1. Department of Neonatology, Children's University Hospital, Dublin, Ireland; Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Pediatrics, University of Melbourne, Melbourne, Australia. 2. Department of Pediatrics, University of Melbourne, Melbourne, Australia; Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, Australia. 3. Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Australia. 4. Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia. 5. Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Turner Institute of Brain and Mental Health, Monash University, Melbourne, Australia. 6. Department of Pediatrics, University of Melbourne, Melbourne, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia. 7. Department of Occupational Therapy, The Royal Children's Hospital, Melbourne, Australia. 8. Department of Pediatrics, University of Melbourne, Melbourne, Australia; Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: rod.hunt@rch.org.au.
Abstract
OBJECTIVE: To examine the associations of neonatal noncardiac surgery with newborn brain structure and neurodevelopment at 2 years of age. STUDY DESIGN: Infants requiring neonatal noncardiac surgery for congenital diaphragmatic hernia, esophageal atresia, or anterior abdominal wall defect were compared with infants who did not require surgery, matched for sex, gestation at birth, and postmenstrual age at magnetic resonance imaging. Cerebral magnetic resonance imaging was performed at a mean (SD) postmenstrual age of 41.6 (1.7) weeks. Images were assessed qualitatively for brain maturation and injury and quantitatively for measures of brain size, cerebrospinal fluid spaces, and global abnormality. Neurodevelopment was then assessed at 2 years using the Bayley Scales of Infant and Toddler Development, 3rd edition. RESULTS: Infants requiring surgery (n = 39) were 5.9 times (95% CI, 1.9-19.5; P < .01) more likely to have delayed gyral maturation and 9.8 times (95% CI, 1.2-446; P = .01) more likely to have white matter signal abnormalities compared with controls (n = 39). Cases were more likely to have higher global abnormality scores, smaller biparietal diameters, and larger ventricular sizes than controls. Infants who had surgery had lower mean composite scores in the language (mean difference, -12.5; 95% CI, -22.4 to -2.7) and motor domains (mean difference, -13.4; 95% CI, -21.1 to -5.6) compared with controls. CONCLUSIONS: Infants requiring neonatal noncardiac surgery have smaller brains with more abnormalities compared with matched controls and have associated neurodevelopmental impairment at 2 years of age. Prospective studies with preoperative and postoperative imaging would assist in determining the timing of brain injury. Crown
OBJECTIVE: To examine the associations of neonatal noncardiac surgery with newborn brain structure and neurodevelopment at 2 years of age. STUDY DESIGN:Infants requiring neonatal noncardiac surgery for congenital diaphragmatic hernia, esophageal atresia, or anterior abdominal wall defect were compared with infants who did not require surgery, matched for sex, gestation at birth, and postmenstrual age at magnetic resonance imaging. Cerebral magnetic resonance imaging was performed at a mean (SD) postmenstrual age of 41.6 (1.7) weeks. Images were assessed qualitatively for brain maturation and injury and quantitatively for measures of brain size, cerebrospinal fluid spaces, and global abnormality. Neurodevelopment was then assessed at 2 years using the Bayley Scales of Infant and Toddler Development, 3rd edition. RESULTS:Infants requiring surgery (n = 39) were 5.9 times (95% CI, 1.9-19.5; P < .01) more likely to have delayed gyral maturation and 9.8 times (95% CI, 1.2-446; P = .01) more likely to have white matter signal abnormalities compared with controls (n = 39). Cases were more likely to have higher global abnormality scores, smaller biparietal diameters, and larger ventricular sizes than controls. Infants who had surgery had lower mean composite scores in the language (mean difference, -12.5; 95% CI, -22.4 to -2.7) and motor domains (mean difference, -13.4; 95% CI, -21.1 to -5.6) compared with controls. CONCLUSIONS:Infants requiring neonatal noncardiac surgery have smaller brains with more abnormalities compared with matched controls and have associated neurodevelopmental impairment at 2 years of age. Prospective studies with preoperative and postoperative imaging would assist in determining the timing of brain injury. Crown
Authors: Kristin Keunen; Nicolaas H Sperna Weiland; Bernadette S de Bakker; Linda S de Vries; Markus F Stevens Journal: Paediatr Anaesth Date: 2022-03-16 Impact factor: 2.129
Authors: Dries Hendrikx; Sophie A Costerus; Katrin Zahn; Alba Perez-Ortiz; Alexander Caicedo Dorado; Sabine Van Huffel; Jurgen de Graaff; René Wijnen; Lucas Wessel; Dick Tibboel; Gunnar Naulaers Journal: Eur J Anaesthesiol Date: 2021-12-01 Impact factor: 4.183