Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis

Arch Dis Child Fetal Neonatal Ed. 2021 Nov;106(6):635-642. doi: 10.1136/archdischild-2021-322158. Epub 2021 Jun 10.

Abstract

Aim: 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.

Method: 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.

Results: 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.

Interpretation: 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.

Keywords: gastroenterology; neonatology; neuropathology; psychology.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Child
  • Child Development
  • Digestive System Abnormalities* / classification
  • Digestive System Abnormalities* / complications
  • Digestive System Abnormalities* / epidemiology
  • Digestive System Abnormalities* / psychology
  • Gastrointestinal Tract / abnormalities*
  • Humans
  • Neurodevelopmental Disorders* / classification
  • Neurodevelopmental Disorders* / diagnosis
  • Neurodevelopmental Disorders* / epidemiology
  • Neurodevelopmental Disorders* / etiology
  • Risk Assessment