Department of Neonatology, Children's University Hospital, Dublin, Ireland; Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
Department of Pediatrics, University of Melbourne, Melbourne, Australia; Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, Australia.
J Pediatr. 2019 Sep;212:93-101.e2. doi: 10.1016/j.jpeds.2019.05.050. Epub 2019 Jun 22.
To examine the associations of neonatal noncardiac surgery with newborn brain structure and neurodevelopment at 2 years of age.
Infants requiring neonatal noncardiac surgery for congenital diaphragmatic hernia, esophageal atresia, or anterior abdominal wall defect were compared with infants who did not require surgery, matched for sex, gestation at birth, and postmenstrual age at magnetic resonance imaging. Cerebral magnetic resonance imaging was performed at a mean (SD) postmenstrual age of 41.6 (1.7) weeks. Images were assessed qualitatively for brain maturation and injury and quantitatively for measures of brain size, cerebrospinal fluid spaces, and global abnormality. Neurodevelopment was then assessed at 2 years using the Bayley Scales of Infant and Toddler Development, 3rd edition.
Infants requiring surgery (n = 39) were 5.9 times (95% CI, 1.9-19.5; P < .01) more likely to have delayed gyral maturation and 9.8 times (95% CI, 1.2-446; P = .01) more likely to have white matter signal abnormalities compared with controls (n = 39). Cases were more likely to have higher global abnormality scores, smaller biparietal diameters, and larger ventricular sizes than controls. Infants who had surgery had lower mean composite scores in the language (mean difference, -12.5; 95% CI, -22.4 to -2.7) and motor domains (mean difference, -13.4; 95% CI, -21.1 to -5.6) compared with controls.
Infants requiring neonatal noncardiac surgery have smaller brains with more abnormalities compared with matched controls and have associated neurodevelopmental impairment at 2 years of age. Prospective studies with preoperative and postoperative imaging would assist in determining the timing of brain injury.
研究新生儿非心脏手术与 2 岁时新生儿大脑结构和神经发育的关系。
患有先天性膈疝、食管闭锁或前腹壁缺陷的新生儿非心脏手术患儿与未接受手术的患儿相匹配，匹配性别、出生时胎龄和磁共振成像时的校正胎龄。平均（SD）校正胎龄为 41.6（1.7）周时进行脑磁共振成像。对大脑成熟和损伤进行定性评估，对大脑大小、脑脊液空间和整体异常进行定量评估。然后在 2 岁时使用贝利婴幼儿发育量表第三版评估神经发育。
需要手术的婴儿（n=39）发生脑回发育延迟的可能性是对照组（n=39）的 5.9 倍（95%CI，1.9-19.5；P<.01），发生白质信号异常的可能性是对照组的 9.8 倍（95%CI，1.2-446；P=.01）。与对照组相比，病例组更有可能出现更高的总体异常评分、更小的双侧顶骨直径和更大的脑室大小。与对照组相比，接受手术的婴儿在语言（平均差异，-12.5；95%CI，-22.4 至-2.7）和运动（平均差异，-13.4；95%CI，-21.1 至-5.6）领域的平均综合评分较低。
与匹配对照组相比，需要新生儿非心脏手术的婴儿大脑较小，异常较多，2 岁时存在神经发育障碍。具有术前和术后影像学的前瞻性研究将有助于确定脑损伤的时间。
