title: Surgery and neurodevelopmental outcome of very low-birth-weight infants.
abstract: OBJECTIVE
  Reduced death and neurodevelopmental impairment among infants is a goal of perinatal medicine.
  
  
  OBJECTIVE
  To assess the association between surgery during the initial hospitalization and death or neurodevelopmental impairment of very low-birth-weight infants.
  
  
  METHODS
  A retrospective cohort analysis was conducted of patients enrolled in the National Institute of Child Health and Human Development Neonatal Research Network Generic Database from 1998 through 2009 and evaluated at 18 to 22 months' corrected age. Twenty-two academic neonatal intensive care units participated. Inclusion criteria were birth weight 401 to 1500 g, survival to 12 hours, and availability for follow-up. A total of 12 111 infants were included in analyses.
  
  
  METHODS
  Surgical procedures; surgery also was classified by expected anesthesia type as major (general anesthesia) or minor (nongeneral anesthesia).
  
  
  METHODS
  Multivariable logistic regression analyses planned a priori were performed for the primary outcome of death or neurodevelopmental impairment and for the secondary outcome of neurodevelopmental impairment among survivors. Multivariable linear regression analyses were performed as planned for the adjusted mean scores of the Mental Developmental Index and Psychomotor Developmental Index of the Bayley Scales of Infant Development, Second Edition, for patients born before 2006.
  
  
  RESULTS
  A total of 2186 infants underwent major surgery, 784 had minor surgery, and 9141 infants did not undergo surgery. The risk-adjusted odds ratio of death or neurodevelopmental impairment for all surgery patients compared with those who had no surgery was 1.29 (95% CI, 1.08-1.55). For patients who had major surgery compared with those who had no surgery, the risk-adjusted odds ratio of death or neurodevelopmental impairment was 1.52 (95% CI, 1.24-1.87). Patients classified as having minor surgery had no increased adjusted risk. Among survivors who had major surgery compared with those who had no surgery, the adjusted risk of neurodevelopmental impairment was greater and the adjusted mean Bayley scores were lower.
  
  
  CONCLUSIONS
  Major surgery in very low-birth-weight infants is independently associated with a greater than 50% increased risk of death or neurodevelopmental impairment and of neurodevelopmental impairment at 18 to 22 months' corrected age. The role of general anesthesia is implicated but remains unproven.
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City.
authors.forename: Frank H
authors.initials: FH
authors.lastname: Morriss
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina.
authors.forename: Shampa
authors.initials: S
authors.lastname: Saha
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City.
authors.forename: Tarah T
authors.initials: TT
authors.lastname: Colaizy
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan.
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.affiliation: Department of Pediatrics, Women & Infants' Hospital, Brown University, Providence, Rhode Island.
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Shannon E G
authors.initials: SE
authors.lastname: Hamrick
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan.
authors.forename: Athina
authors.initials: A
authors.lastname: Pappas
authors.affiliation: Department of Pediatrics, University of Texas Medical School, Houston.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Jones
authors.affiliation: Division of Neonatology, University of Alabama, Birmingham.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: Department of Pediatrics, Women & Infants' Hospital, Brown University, Providence, Rhode Island.
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 10now Department of Pediatrics, College of Medicine, The Ohio State University, Columbus.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Hale
authors.affiliation: Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Newman
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D000758:Anesthesia / Q000379:methods; D002658:Developmental Disabilities / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology