Major surgery increases infants’ risk for death, neurodevelopmental impairment

Very low birth weight infants who undergo major surgery have an increased risk for death or neurodevelopmental impairment, according to study findings in JAMA Pediatrics.

Frank H. Morriss, MD, MPH, of the department of pediatrics, University of Iowa, Iowa City, and colleagues analyzed data from 1998 through 2009 from the Neonatal Research Network generic database. During this time period, there were 12,111 infants with a birth weight of 401 g to 1,500 g. Of these, 2,970 had surgery during initial hospitalization. Follow-up assessments were conducted at 18 to 22 months calculated age.

The study cohort consisted of 2,186 infants who had major surgery; 784 who had minor surgery; and 9,141 who had no surgery. Of those who underwent surgery, 1,080 had multiple surgeries.

Infants who underwent surgery had higher adjusted odds for death or neurodevelopmental impairment compared with those who did not (OR=1.29; 95% CI, 1.08-1.55). Those who underwent major surgery had increased adjusted odds for death or neurodevelopmental impairment compared with those who did not have surgery (OR=1.52; 95% CI, 1.24-1.87) and those who had minor surgery (OR=1.45; 95% CI, 1.14-1.85). There was no significant difference in risk for death or neurodevelopmental impairment between infants who had minor surgery or no surgery at all. As the number of surgeries increased, so did risk for death or neurodevelopmental impairment.

Specific type of anesthesia was not documented and data on dosing and other administered drugs were unavailable.

“As is true with every human neurotoxicity study to date, their work raises as many questions as it answers,” Robert Williams, MD, Robert Pfister, MD, and Ian Black, MD, of the department of anesthesia, Vermont Children’s Hospital, University of Vermont, wrote in an accompanying editorial.

“Although there is no current evidence to indicate the superiority of any specific anesthetic technique, the use of regional anesthesia (typically, infant spinal anesthesia) should be considered. Several surgical procedures, including inguinal hernia repair, gastroschisis repair, circumcision, and pyloromyotomy, can be performed using spinal anesthesia,” the editorialists recommended. “Infant spinal anesthesia has an established record of safety and can be used for surgical procedures in the abdomen and lower extremities.”

Disclosure: The researchers report no relevant financial disclosures.

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Source:

Morriss FH. JAMA Pediatr. 2014; doi:10.1001/jamapediatrics.2014.307.