Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 21;101(21):952-957.
doi: 10.1212/WNL.0000000000207848. Epub 2023 Oct 11.

Major Surgery, Brain Injury, and Neurodevelopmental Outcomes in Very Preterm Infants

Thiviya Selvanathan  1 , Stephanie H Au-Young  1 , Ting Guo  1 , Vann Chau  1 , Helen M Branson  1 , Anne Synnes  1 , Linh Ly  1 , Edmond N Kelly  1 , Ruth E Grunau  1 , Steven P Miller  2
Affiliations

Major Surgery, Brain Injury, and Neurodevelopmental Outcomes in Very Preterm Infants

Thiviya Selvanathan et al. Neurology. .

Abstract

Objectives: We determined whether (1) major surgery is associated with an increased risk for brain injury and adverse neurodevelopment and (2) brain injury modifies associations between major surgery and neurodevelopment in very preterm infants.

Methods: Prospectively enrolled infants across 3 tertiary neonatal intensive care units underwent early-life and/or term-equivalent age MRI to detect moderate-severe brain injury. Eighteen-month neurodevelopmental outcomes were assessed with Bayley Scales of Infant and Toddler Development, third edition. Multivariable logistic and linear regressions were used to determine associations of major surgery with brain injury and neurodevelopment, adjusting for clinical confounders.

Results: There were 294 infants in this study. Major surgery was associated with brain injury (odds ratio 2.54, 95% CI 1.12-5.75, p = 0.03) and poorer motor outcomes (β = -7.92, 95% CI -12.21 to -3.64, p < 0.001), adjusting for clinical confounders. Brain injury x major surgery interaction significantly predicted motor scores (p = 0.04): Lowest motor scores were in infants who required major surgery and had brain injury.

Discussion: There is an increased risk for brain injury and adverse motor outcomes in very preterm infants who require major surgery, which may be a marker of clinical illness severity. Routine brain MRI to detect brain injury and close neurodevelopmental surveillance should be considered in this subgroup of infants.

PubMed Disclaimer

Conflict of interest statement

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Figures

Figure
Figure. Boxplots of Bayley-3 Motor, Cognitive, and Language Scores in Children Who Did and Did Not Undergo Major Surgery, Separated by Children With and Without Moderate-Severe Brain Injury
See this image and copyright information in PMC

References

    1. Guillot M, Chau V, Lemyre B. Routine imaging of the preterm neonatal brain. Paediatr Child Health. 2020;25(4):249-262. doi:10.1093/pch/pxaa033 - DOI - PMC - PubMed
    1. Inder TE, de Vries LS, Ferriero DM, et al. . Neuroimaging of the preterm brain: review and recommendations. J Pediatr. 2021;237:276-287.e4. doi:10.1016/j.jpeds.2021.06.014 - DOI - PubMed
    1. Hunt RW, Hickey LM, Burnett AC, Anderson PJ, Cheong JLY, Doyle LW. Early surgery and neurodevelopmental outcomes of children born extremely preterm. Arch Dis Child Fetal Neonatal Ed. 2018;103(3):F227-F232. doi:10.1136/archdischild-2017-313161 - DOI - PubMed
    1. Morriss FH Jr, Saha S, Bell EF, et al. . Surgery and neurodevelopmental outcome of very low-birth-weight infants. JAMA Pediatr. 2014;168(8):746-754. doi:10.1001/jamapediatrics.2014.307 - DOI - PMC - PubMed
    1. Gano D, Andersen SK, Glass HC, et al. . Impaired cognitive performance in premature newborns with two or more surgeries prior to term-equivalent age. Pediatr Res. 2015;78(3):323-329. doi:10.1038/pr.2015.106 - DOI - PMC - PubMed

Publication types