Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2021 Nov;106(6):635-642. doi: 10.1136/archdischild-2021-322158. Epub 2021 Jun 10.
Children with congenital gastrointestinal malformations may be at risk of neurodevelopmental impairment due to challenges to the developing brain, including perioperative haemodynamic changes, exposure to anaesthetics and postoperative inflammatory influences. This study aggregates existing evidence on neurodevelopmental outcome in these patients using meta-analysis.
PubMed, Embase and Web of Science were searched for peer-reviewed articles published until October 2019. Out of the 5316 unique articles that were identified, 47 studies met the inclusion criteria and were included. Standardised mean differences (Cohen's d) between cognitive, motor and language outcome of patients with congenital gastrointestinal malformations and normative data (39 studies) or the studies' control group (8 studies) were aggregated across studies using random-effects meta-analysis. The value of (clinical) moderators was studied using meta-regression and diagnostic subgroups were compared.
The 47 included studies encompassed 62 cohorts, representing 2312 patients. Children with congenital gastrointestinal malformations had small-sized cognitive impairment (d=-0.435, p<0.001; 95% CI -0.567 to -0.302), medium-sized motor impairment (d=-0.610, p<0.001; 95% CI -0.769 to -0.451) and medium-sized language impairment (d=-0.670, p<0.001; 95% CI -0.914 to -0.425). Patients with short bowel syndrome had worse motor outcome. Neurodevelopmental outcome was related to the number of surgeries and length of total hospital stay, while no relations were observed with gestational age, birth weight, age and sex.
This study shows that children with congenital gastrointestinal malformations exhibit impairments in neurodevelopmental outcome, highlighting the need for routine screening of neurodevelopment during follow-up.
由于对发育中大脑的挑战，包括围手术期血流动力学变化、麻醉暴露和术后炎症影响，患有先天性胃肠道畸形的儿童可能存在神经发育受损的风险。本研究通过荟萃分析汇总了这些患者神经发育结果的现有证据。
在 PubMed、Embase 和 Web of Science 上检索截至 2019 年 10 月发表的同行评议文章。从确定的 5316 篇独特文章中，有 47 项研究符合纳入标准并被纳入。使用随机效应荟萃分析，对先天性胃肠道畸形患者与认知、运动和语言结果的标准均数差（Cohen's d）进行汇总，这些患者的认知、运动和语言结果来自于文献研究（39 项研究）或研究的对照组（8 项研究）。使用元回归研究（临床）调节变量的价值，并比较诊断亚组。
纳入的 47 项研究共包含 62 个队列，代表 2312 例患者。患有先天性胃肠道畸形的儿童存在认知功能轻度受损（d=-0.435，p<0.001；95%CI-0.567 至-0.302）、运动功能中度受损（d=-0.610，p<0.001；95%CI-0.769 至-0.451）和语言功能中度受损（d=-0.670，p<0.001；95%CI-0.914 至-0.425）。短肠综合征患者的运动功能更差。神经发育结果与手术次数和总住院时间有关，而与胎龄、出生体重、年龄和性别无关。
本研究表明，患有先天性胃肠道畸形的儿童存在神经发育结果受损，这突出表明需要在随访期间对神经发育进行常规筛查。
