Associations of Neonatal Noncardiac Surgery with Brain Structure and Neurodevelopment: A Prospective Case-Control Study
| Autor: | Peter J. Anderson, Julia K. Gunn-Charlton, Jeanie L.Y. Cheong, Rod W. Hunt, Lex W. Doyle, Jennifer M. Walsh, Margaret M. Moran, Susan Greaves |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Pediatrics Gestational Age Bayley Scales of Infant Development 03 medical and health sciences 0302 clinical medicine 030225 pediatrics medicine Humans Prospective Studies 030212 general & internal medicine Prospective cohort study Esophageal Atresia Hernia Diaphragmatic medicine.diagnostic_test business.industry Abdominal wall defect Abdominal Wall Infant Newborn Postmenstrual Age Brain Congenital diaphragmatic hernia Gestational age Magnetic resonance imaging medicine.disease Magnetic Resonance Imaging Cardiac surgery Brain Injuries Case-Control Studies Surgical Procedures Operative Pediatrics Perinatology and Child Health business |
| Zdroj: | The Journal of Pediatrics. 212:93-101.e2 |
| ISSN: | 0022-3476 |
| DOI: | 10.1016/j.jpeds.2019.05.050 |
| Popis: | To examine the associations of neonatal noncardiac surgery with newborn brain structure and neurodevelopment at 2 years of age.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.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.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. |
| Databáze: | OpenAIRE |
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