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Affiliation
Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia;, Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork,, Republic of Ireland.Issue Date
2012-01-31T16:44:04Z
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J Pediatr. 2011 Oct 31.Journal
The Journal of pediatricsDOI
10.1016/j.jpeds.2011.09.009PubMed ID
22048043Abstract
OBJECTIVE: To investigate the relationship between surgery in very preterm infants and brain structure at term equivalent and 2-year neurodevelopmental outcome. STUDY DESIGN: A total of 227 infants born at <30 weeks gestation or at a birth weight of <1250 g were prospectively enrolled into a longitudinal observational cohort for magnetic resonance imaging and developmental follow-up. The infants were categorized retrospectively into either a nonsurgical group (n=178) or a surgical group (n=30). Nineteen infants were excluded because of incomplete or unsuitable data. The surgical and nonsurgical groups were compared in terms of clinical demographic data, white matter injury, and brain volume at term. Neurodevelopmental outcome was assessed at age 2 years. RESULTS: Compared with the nonsurgical group, the infants in the surgical group were smaller and more growth-restricted at birth, received more respiratory support and oxygen therapy, and had longer hospital stays. They also had smaller brain volumes, particularly smaller deep nuclear gray matter volumes. Infants who underwent bowel surgery had greater white matter injury. Mental Developmental Index scores were lower in the surgical group, whereas Psychomotor Developmental Index scores did not differ between the groups. The Mental Developmental Index difference became nonsignificant after adjustment for confounding variables. CONCLUSION: Preterm infants exposed to surgery and anesthesia had greater white matter injury and smaller total brain volumes, particularly smaller deep nuclear gray matter volumes. Surgical exposure in the preterm infant should alert the clinician to an increased risk for adverse cognitive outcome.Language
ENGISSN
1097-6833 (Electronic)0022-3476 (Linking)
ae974a485f413a2113503eed53cd6c53
10.1016/j.jpeds.2011.09.009