title: Neurologic outcomes in very preterm infants undergoing surgery.
abstract: OBJECTIVE
  To investigate the relationship between surgery in very preterm infants and brain structure at term equivalent and 2-year neurodevelopmental outcome.
  
  
  METHODS
  A total of 227 infants born at <30 weeks gestation or at a birth weight of <1250 g were prospectively enrolled into a longitudinal observational cohort for magnetic resonance imaging and developmental follow-up. The infants were categorized retrospectively into either a nonsurgical group (n=178) or a surgical group (n=30). Nineteen infants were excluded because of incomplete or unsuitable data. The surgical and nonsurgical groups were compared in terms of clinical demographic data, white matter injury, and brain volume at term. Neurodevelopmental outcome was assessed at age 2 years.
  
  
  RESULTS
  Compared with the nonsurgical group, the infants in the surgical group were smaller and more growth-restricted at birth, received more respiratory support and oxygen therapy, and had longer hospital stays. They also had smaller brain volumes, particularly smaller deep nuclear gray matter volumes. Infants who underwent bowel surgery had greater white matter injury. Mental Developmental Index scores were lower in the surgical group, whereas Psychomotor Developmental Index scores did not differ between the groups. The Mental Developmental Index difference became nonsignificant after adjustment for confounding variables.
  
  
  CONCLUSIONS
  Preterm infants exposed to surgery and anesthesia had greater white matter injury and smaller total brain volumes, particularly smaller deep nuclear gray matter volumes. Surgical exposure in the preterm infant should alert the clinician to an increased risk for adverse cognitive outcome.
authors: Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia. peter.filan@hse.ie
authors: Peter M
authors: PM
authors: Filan
authors: Rod W
authors: RW
authors: Hunt
authors: Peter J
authors: PJ
authors: Anderson
authors: Lex W
authors: LW
authors: Doyle
authors: Terrie E
authors: TE
authors: Inder
mesh_terms: D000758:Anesthesia / Q000009:adverse effects; D001921:Brain / Q000473:pathology*; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition; D004374:Ductus Arteriosus, Patent / Q000601:surgery; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000473:pathology / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D007422:Intestines / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D011597:Psychomotor Performance; D013514:Surgical Procedures, Operative / Q000009:adverse effects*