The Impact of Surgical Intervention on Neurodevelopmental Outcomes in Very Low Birth Weight Infants: a Nationwide Cohort Study in Korea

Abstract

BackgroundTo investigate the incidence of surgical intervention in very low birth weight (VLBW) infants and the impact of surgery on neurodevelopmental outcomes at corrected ages (CAs) of 18–24 months, using data from the Korean Neonatal Network (KNN).MethodsData from 7,885 VLBW infants who were born and registered with the KNN between 2013 to 2016 were analyzed in this study. The incidences of various surgical interventions and related morbidities were analyzed. Long-term neurodevelopmental outcomes at CAs of 18–24 months were compared between infants (born during 2013 to 2015, n = 3,777) with and without surgery.ResultsA total of 1,509 out of 7,885 (19.1%) infants received surgical interventions during neonatal intensive care unit (NICU) hospitalization. Surgical ligation of patent ductus arteriosus (n = 840) was most frequently performed, followed by laser therapy for retinopathy of prematurity and laparotomy due to intestinal perforation. Infants who underwent surgery had higher mortality rates and greater neurodevelopmental impairment than infants who did not undergo surgery (P value < 0.01, both). On multivariate analysis, single or multiple surgeries increased the risk of neurodevelopmental impairment compared to no surgery with adjusted odds ratios (ORs) of 1.6 with 95% confidence interval (CI) of 1.1–2.6 and 2.3 with 95% CI of 1.1–4.9.ConclusionApproximately one fifth of VLBW infants underwent one or more surgical interventions during NICU hospitalization. The impact of surgical intervention on long-term neurodevelopmental outcomes was sustained over a follow-up of CA 18–24 months. Infants with multiple surgeries had an increased risk of neurodevelopmental impairment compared to infants with single surgeries or no surgeries after adjustment for possible confounders.

Targeting Risk Factors for the Control of Central Line-Associated Bloodstream Infection in the Neonatal Intensive Care Unit: A Single Tertiary Center Experience

“…In our study, the CLABSI group showed a higher proportion of surgical treatment (P=0.006). As a tertiary NICU, the proportion of patients who needed surgical treatment, including pediatric surgery, neurosurgery, cardiothoracic surgery, urologic surgery, and otorhinolaryngologic surgery, was higher (43.3%) than in other Korean NICUs 12) . The reason why surgery is associated with an increased occurrence of CLABSI is unclear.…”

“…The patients' SNAP-II were categorized as normal (0), mild (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), moderate (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), and severe (>40).…”

Cognitive Outcomes in Children With Conditions Affecting the Small Intestine

“…Eleven studies were of retrospective design (19,23–32), 19 of prospective design (20–22,33–48). Sample size across studies ranged from 10 to 449 patients.…”

“…Eleven studies were of retrospective design (19,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), 19 of prospective design (20)(21)(22)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). Sample size across studies ranged from 10 to 449 patients.…”

Increased Risk of Meconium-Related Ileus in Extremely Premature Infants Exposed to Antenatal Magnesium Sulfate

“…It is well known that surgical intervention and general anesthesia increase the incidence of neurodevelopmental impairment in preterm infants. Previous studies using national registry data showed that surgery during NICU hospitalization in preterm infants was an independent risk factor for various neurodevelopmental impairments at the age of 2 years or later [39, 40]. Therefore, the question of whether surgery in this early and vulnerable period of life might offset the beneficial fetal neuroprotective effect should be answered.…”