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JAMA Pediatr. 2014 Aug;168(8):746-54. doi: 10.1001/jamapediatrics.2014.307.

Surgery and neurodevelopmental outcome of very low-birth-weight infants.

Collaborators (252)

Jobe AH, Caplan MS, Oh W, Burke RT, Stephens BE, Yatchmink Y, Alksninis B, Hensman AM, Leach TM, Leonard MR, Noel L, Vogt RA, Watson VE, Walsh MC, Fanaroff AA, Wilson-Costello DE, Siner BS, Friedman HG, Schibler K, Donovan EF, Bridges K, Steichen JJ, Yolton K, Alexander B, Fischer EE, Grisby C, Mersmann MW, Mincey HL, Hessling J, Gratton TL, Jackson LD, Kirker K, Goldberg RN, Cotten C, Goldstein RF, Auten KJ, Fisher KA, Foy KA, Gustafson KE, Lohmeyer MB, Carlton DP, Adams-Chapman I, Wright LL, McClure EM, Archer SW, Poindexter BB, Lemons JA, Dusick A, Lytle C, Bohnke LG, Eaken G, Hamer F, Herron DE, Miller LC, Minnich HM, Richard L, Wilson LD, Poole WK, Wallace D, Newman JE, Auman JO, Crawford MM, Hastings BK, McClure EM, Petrie Huitema CM, Zaterka-Baxter KM, Stevenson DK, Adams MM, Ahlfors CE, Ball M, Baran JM, Bentley B, Bond LE, Brudos GK, Davis AS, DeAnda ME, DeBattista AM, Fleisher BE, Kohn JG, Lee-Ancajas JC, Palmquist AW, Proud MS, Pyle RP, Sivakumar D, Stebbins RD, St John NH, Frantz ID 3rd, McGowan EC, MacKinnon BL, Nylen E, Furey A, Sibley C, Brussa A, Ambalavanan N, Peralta-Carcelen M, Nelson KG, Bailey KJ, Biasini FJ, Chopko SA, Collins MV, Cosby SS, Moses MB, Phillips VA, Preskitt J, Rector RV, Whitley S, Finer NN, Rasmussen MR, Vaucher YE, Wozniak PR, Arnell K, Bridge R, Demetrio C, Fuller MG, Rich W, Widness JA, Acarregui MJ, Johnson KJ, Eastman DL, Bauer CR, Duara S, Everett-Thomas R, Worth AM, Allison M, Diaz AN, Mathews EE, Hamlin-Smith K, Jean-Gilles L, Calejo M, Frade Eguaras SM, Fajardo-Hiriart S, Gideon YC, Berkovits MH, Stoerger A, Garcia A, Pierre H, Roder G, Riguad A, Watterberg KL, Duncan AF, Fuller J, Ohls RK, Papile LA, Lacy CB, Brown S, Lowe JR, Montman R, Phelps DL, Guillet R, Myers GJ, Reubens LJ, Burnell E, Rowan M, Horihan CA, Johnson JB, Hust D, Jensen RL, Kushner E, Merzbach J, Yost K, Zwetsch L, Korones SB, Bada HS, Hudson T, Williams M, Yolton K, Rosenfeld CR, Salhab WA, Brion LP, Broyles R, Heyne RJ, Adams SS, Burchfield J, Dooley C, Guzman A, Hensley G, Heyne ET, Hickman JF, Leps MH, Madden LA, Miller NA, Morgan JS, Madison S, Torres LE, Boatman CT, Vasil DM, Baines L, Kennedy KA, Tyson JE, Evans PW, Akpa EG, Guajardo MC, Dieterich SE, Harris BF, Franco CI, Green C, Jiminez M, Lis AE, Major-Kincade T, Martin SC, McDavid G, Morris BH, Orekoya PA, Pierce Tate PL, Poundstone M, Reddoch S, Siddiki SK, Simmons MC, Whitely LL, Wright SL, Faix RG, Yoder BA, Steffen M, Baker S, Bird K, Burnett J, Jensen J, Osborne KA, Spencer C, Weaver-Lewis K, O'Shea TM, Dillard RG, Peters NJ, Chiu K, Allred DE, Goldstein DJ, Halfond R, Jackson BG, Peterson C, Waldrep EL, Morris MW, Hounshell GW, Sood BG, Johnson YR, Bara R, Goldston L, Johnson ME, Kennedy D, Muran G, Ehrenkranz RA, Butler C, Jacobs H, Cervone P, Close N, Gettner P, Gilliam W, Greisman S, Konstantino M, Poulsen J, Romano E, Taft J, Williams J.

Author information

1
Department of Pediatrics, University of Iowa, Iowa City.
2
Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina.
3
Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.
4
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California.
5
Department of Pediatrics, Wayne State University, Detroit, Michigan.
6
Department of Pediatrics, Women & Infants' Hospital, Brown University, Providence, Rhode Island.
7
Department of Pediatrics, University of Texas Medical School, Houston.
8
Division of Neonatology, University of Alabama, Birmingham.
9
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 10now Department of Pediatrics, College of Medicine, The Ohio State University, Columbus.
10
Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
11
Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland.
12
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.

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.

PMID:
24934607
PMCID:
PMC4142429
DOI:
10.1001/jamapediatrics.2014.307
[Indexed for MEDLINE]
Free PMC Article

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