Department of Neonatology, University Medical Center, Utrecht Brain Center and Wilhelmina Children's Hospital, University Utrecht, Utrecht, Netherlands.
Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
Pediatr Res. 2023 Oct;94(4):1265-1272. doi: 10.1038/s41390-023-02629-8. Epub 2023 May 22.
There is growing evidence that neonatal surgery for non-cardiac congenital anomalies (NCCAs) in the neonatal period adversely affects long-term neurodevelopmental outcome. However, less is known about acquired brain injury after surgery for NCCA and abnormal brain maturation leading to these impairments.
A systematic search was performed in PubMed, Embase, and The Cochrane Library on May 6, 2022 on brain injury and maturation abnormalities seen on magnetic resonance imaging (MRI) and its associations with neurodevelopment in neonates undergoing NCCA surgery the first month postpartum. Rayyan was used for article screening and ROBINS-I for risk of bias assessment. Data on the studies, infants, surgery, MRI, and outcome were extracted.
Three eligible studies were included, reporting 197 infants. Brain injury was found in n = 120 (50%) patients after NCCA surgery. Sixty (30%) were diagnosed with white matter injury. Cortical folding was delayed in the majority of cases. Brain injury and delayed brain maturation was associated with a decrease in neurodevelopmental outcome at 2 years of age.
Surgery for NCCA was associated with high risk of brain injury and delay in maturation leading to delay in neurocognitive and motor development. However, more research is recommended for strong conclusions in this group of patients.
Brain injury was found in 50% of neonates who underwent NCCA surgery. NCCA surgery is associated with a delay in cortical folding. There is an important research gap regarding perioperative brain injury and NCCA surgery.
越来越多的证据表明，新生儿期非心脏先天性畸形（NCCA）的手术会对长期神经发育结果产生不利影响。然而，对于 NCCA 手术后获得性脑损伤以及导致这些损伤的异常脑成熟知之甚少。
2022 年 5 月 6 日，在 PubMed、Embase 和 The Cochrane Library 中对新生儿期 NCCA 手术后磁共振成像（MRI）上可见的脑损伤和成熟异常及其与新生儿神经发育的关系进行了系统检索。使用 Rayyan 进行文章筛选，使用 ROBINS-I 进行偏倚风险评估。提取关于研究、婴儿、手术、MRI 和结果的数据。
纳入了 3 项符合条件的研究，共报告了 197 名婴儿。NCCA 手术后有 n = 120（50%）名患者发现脑损伤。60 名（30%）患者被诊断为白质损伤。在大多数情况下，皮质折叠延迟。脑损伤和脑成熟延迟与 2 岁时神经发育结果下降相关。
NCCA 手术与脑损伤风险增加和成熟延迟相关，导致神经认知和运动发育延迟。然而，对于这组患者，建议进行更多的研究以得出更有力的结论。
接受 NCCA 手术的新生儿中有 50%发现脑损伤。NCCA 手术与皮质折叠延迟有关。关于围手术期脑损伤和 NCCA 手术，存在重要的研究空白。
