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Original article
Early surgery and neurodevelopmental outcomes of children born extremely preterm
  1. Rodney W Hunt1,2,3,4,
  2. Leah M Hickey1,
  3. Alice C Burnett1,3,4,5,
  4. Peter J Anderson3,4,
  5. Jeanie Ling Yoong Cheong2,3,4,5,
  6. Lex W Doyle5,6
  7. for the Victorian Infant Collaborative Study group
  1. 1 Department of Neonatal Medicine, Royal Children’s Hospital, Melbourne, Australia
  2. 2 Department of Clinical Science, Murdoch Childrens Research Institute, Melbourne, Australia
  3. 3 Department of Paediatrics, University of Melbourne, Melbourne, Australia
  4. 4 Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia
  5. 5 Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
  6. 6 Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
  1. Correspondence to Dr Rodney W Hunt, Department of Neonatal Medicine, Royal Children’s Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; rod.hunt{at}rch.org.au

Abstract

Objectives To (1) compare the neurodevelopmental outcomes at 8 years of age of children born extremely preterm (EP) who underwent surgical procedures during the course of their initial hospital admission with those who did not and (2) compare the outcomes across eras, from 1991 to 2005.

Design Prospective observational cohort studies conducted over three different eras (1991-1992, 1997 and 2005). Surviving EP children, who required surgical intervention during the primary hospitalisation, were assessed for general intelligence (IQ) and neurosensory status at 8 years of age. Major neurosensory disability comprised any of moderate/severe cerebral palsy, IQ less than -2 SD relative to term controls, blindness or deafness.

Results Overall, 29% (161/546) of survivors had surgery during the newborn period, with similar rates in each era. Follow-up rates at 8 years were high (91%; 499/546), and 17% (86/499) of survivors assessed had a major neurosensory disability. Rates of major neurosensory disability were substantially higher in the surgical group (33%; 52/158) compared with those who did not have surgery (10%; 34/341) (OR 4.28, 95% CI 2.61 to 7.03). Rates of disability in the surgical group did not improve over time. After adjustment for relevant confounders, no specific surgical procedure was associated with increased risk of disability.

Implications and relevance Major neurosensory disability at 8 years was higher in children born EP who underwent surgery during their initial hospital admission compared with those who did not. The rates of major neurosensory disability in the surgical cohort are not improving over time.

  • neonatology
  • neurodevelopment
  • epidemiology
  • paediatric surgery

https://doi.org/10.1136/archdischild-2017-313161

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    Footnotes

    • RWH contributed equally.

    • Contributors RWH: conception and design of the study, data interpretation, drafting and revising the article and approval of the final manuscript as submitted. LMH: conception and design of the study, data interpretation, drafting and revising the article and approval of the final manuscript as submitted. ACB: conception and design of the study, data interpretation, drafting and revising the article and approval of the final manuscript as submitted. PJA: conception and design of the study, data interpretation, drafting and revising the article and approval of the final manuscript as submitted. JLYC: conception and design of the study, data interpretation, drafting and revising the article and approval of the final manuscript as submitted. LWD: conception and design of the study, obtaining funding, data analysis and interpretation, drafting and revising the article and approval of the final manuscript as submitted.

    • Funding Supported by grants from the National Health and Medical Research Council of Australia (Centre of Clinical Research Excellence #546519; Centre of Research Excellence #1060733; Early Career Fellowship #1053787 to JC; Senior Research Fellowship #1081288 to PJA) and the Victorian Government’s Operational Infrastructure Support Programme.

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Ethics approval Human Research Ethics Committee, The Royal Children’s Hospital, Melbourne.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Members of the Victorian Infant Collaborative Study Group Convenor: Jeanie Cheong.1,2,3,4 Collaborators (in alphabetical order): Peter Anderson,2,4,5 Alice Burnett,2,4,5,6 Catherine Callanan,4 Elizabeth Carse,7 Margaret P. Charlton,7 Noni Davis,4 Lex W Doyle,1,2,3,4,5 Julianne Duff,4 Leah Hickey,6 Esther Hutchinson,4,6 Marie Hayes,7 Elaine Kelly,4,8 Katherine J Lee,9 Marion McDonald,4 Gillian Opie,8 Gehan Roberts,2,4,5,10 Amanda Williamson8. (1) Neonatal Services, Royal Women’s Hospital, Melbourne, Australia; (2) Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia; (3) Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia; (4) Premature Infant Follow-up Program, Royal Women’s Hospital, Melbourne, Australia; (5) Department of Paediatrics, University of Melbourne, Melbourne, Australia; (6) Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Australia; (7) Newborn Services, Monash Medical Centre, Melbourne, Australia; (8) Neonatal Services, Mercy Hospital for Women, Melbourne, Australia; (9) Clinical Epidemiology and Biostatistics, Murdoch Childrens Research Institute, Melbourne, Australia; (10) Centre for Community and Child Health, The Royal Children’s Hospital, Melbourne, Australia.