Associations of Neonatal Noncardiac Surgery with Brain Structure and Neurodevelopment: A Prospective Case-Control Study

Abstract

To examine the associations of neonatal noncardiac surgery with newborn brain structure and neurodevelopment at 2years 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 2years 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 2years of age. Prospective studies with preoperative and postoperative imaging would assist in determining the timing of brain injury.