Morriss Frank H, Saha Shampa, Bell Edward F, Colaizy Tarah T, Stoll Barbara J, Hintz Susan R, Shankaran Seetha, Vohr Betty R, Hamrick Shannon E G, Pappas Athina, Jones Patrick M, Carlo Waldemar A, Laptook Abbot R, Van Meurs Krisa P, Sánchez Pablo J, Hale Ellen C, Newman Nancy S, Das Abhik, Higgins Rosemary D
Department of Pediatrics, University of Iowa, Iowa City.
Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina.
JAMA Pediatr. 2014 Aug;168(8):746-54. doi: 10.1001/jamapediatrics.2014.307.
Reduced death and neurodevelopmental impairment among infants is a goal of perinatal medicine.
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.
Surgical procedures; surgery also was classified by expected anesthesia type as major (general anesthesia) or minor (nongeneral anesthesia).
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.
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.
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.
降低婴儿死亡率和神经发育障碍是围产期医学的目标。
评估极低出生体重儿首次住院期间手术与死亡或神经发育障碍之间的关联。
设计、地点和参与者：对1998年至2009年纳入美国国立儿童健康与人类发展研究所新生儿研究网络通用数据库并在矫正年龄18至22个月时进行评估的患者进行回顾性队列分析。22个学术性新生儿重症监护病房参与了研究。纳入标准为出生体重401至1500克、存活至12小时且可进行随访。共有12111名婴儿纳入分析。
外科手术；手术还根据预期麻醉类型分为大手术（全身麻醉）或小手术（非全身麻醉）。
对死亡或神经发育障碍的主要结局以及幸存者中神经发育障碍的次要结局进行了预先计划的多变量逻辑回归分析。对2006年之前出生的患者，按照计划对贝利婴儿发育量表第二版的心理发育指数和精神运动发育指数的校正平均分进行了多变量线性回归分析。
共有2186名婴儿接受了大手术，784名接受了小手术，9141名婴儿未接受手术。与未接受手术的患者相比，所有手术患者死亡或神经发育障碍的风险调整比值比为1.29（95%CI，1.08 - 1.55）。与未接受手术者相比，接受大手术的患者死亡或神经发育障碍的风险调整比值比为1.52（95%CI，1.24 - 1.87）。被归类为接受小手术的患者调整后风险未增加。与未接受手术的幸存者相比，接受大手术的幸存者神经发育障碍的调整风险更高，贝利校正平均分更低。
极低出生体重儿接受大手术与死亡或神经发育障碍以及矫正年龄18至22个月时神经发育障碍风险增加超过50%独立相关。全身麻醉的作用受到牵连但尚未得到证实。
