Early neurodevelopmental outcomes of congenital gastrointestinal surgical conditions: a single-centre retrospective study

Abstract

BackgroundEvidence is emerging that surgery in the neonatal period is associated with increased risk of suboptimal neurodevelopmental outcomes (SNDO). The aim of this study was to describe neurodevelopmental outcomes (at 1 year) of neonatal surgery for congenital gastrointestinal surgical conditions (CGSC) and to explore risk factors.MethodsRetrospective study (2005–2014) of infants born ≥34 weeks gestation with CGSC and admitted to the surgical neonatal intensive care unit of Perth Children’s Hospital, Western Australia. Clinical details and 1-year developmental outcomes based on Griffiths Mental Developmental Assessment Scales were collated from the database and by reviewing the medical records of study infants. SNDO was defined as one or more of the following: a general quotient less than 88 (ie, >1 SD below mean), cerebral palsy, blindness or sensorineural deafness. Univariable and multivariable logistic regression analyses were carried out to explore risk factors for SNDO. A total of 413 infants were included, of which 13 died. Median gestation was 37.6 weeks (IQR: 36.4–39.1). Information on developmental outcomes was available from 262 out of 400 survivors. A total of 43/262 (16.4%) had SNDO. On univariable analysis, lower z scores for birth weight, prolonged duration of antibiotics, increased episodes of general anaesthesia and prolonged duration of hospital stay were associated with SNDO. On multivariable analysis, lower z scores for birth weight and prolonged hospital stay were associated with increased risk of SNDO.ConclusionsLate preterm and term infants undergoing neonatal surgery for CGSC may be at risk for SNDO. Studies with longer duration of follow-up are needed to further evaluate the role of potentially modifiable risk factors on their neurodevelopmental outcomes.

Long-term neurodevelopment in children born with esophageal atresia: a systematic review

“… 36 A retrospective study using the GMDS-II at age 12 months ( n = 27) found normal neurodevelopment. 37 …”

“… 24 The study of Batta et al found that birthweight and length of stay in the hospital were associated with neurodevelopment at 1 year of age. 37 …”

“…Overall, inclusion criteria varied among studies. Four studies clearly stated to have excluded patients with syndromal or chromosomal abnormalities, neurological impairment, or intellectual disability, 22 , 24 , 25 , 37 whereas others did not. For example, the cohort of Giúdici et al contained one patient with trisomy 21, one with Edwards syndrome and two with cerebral palsy.…”

Probiotic supplementation in neonates with congenital gastrointestinal surgical conditions: a pilot randomised controlled trial

“…In line with the recent literature, our study found that neonates with CGISC develop postnatal growth restriction for weight and head circumference. 29 , 30 Studies in preterm infants have reported an association between postnatal growth restriction of the head circumference and adverse developmental outcomes. 31 – 33 Hence, it was reassuring that postnatal growth restriction for head circumference was less severe in the probiotic group in our RCT.…”

“…Hence, one could hypothesise that probiotic supplemented group will have better neurodevelopmental outcomes. Our recent retrospective study 30 with a sample size of 400 found the incidence of suboptimal neurodevelopmental outcomes (SNDO) to be 16% in term and near-term neonates with CGISC. A sample size of 516 infants (258 in each arm) will be required to have 80% power at the two-sided 5% significance level to detect a 50% difference in the primary outcome (16% in controls and 8% in the probiotic group).…”