title: Impaired cognitive performance in premature newborns with two or more surgeries prior to term-equivalent age.
abstract: BACKGROUND
  Anesthesia in early childhood is associated with adverse neurodevelopmental outcome; however, it is not known if age at exposure affects the risk of adverse outcome. Our objective was to evaluate the association of the number and timing of anesthetic exposures for surgery with cognitive outcome in a cohort of premature newborns.
  
  
  METHODS
  A cohort study of exposure to anesthesia for surgery in premature newborns (<33 wk gestation) prospectively evaluated with neonatal magnetic resonance imaging (MRI) and neurodevelopmental testing at 3-6 y was employed. Exposure to anesthesia for surgery was classified as before term-equivalent age (TEA, <42 wk postmenstrual age) or after (≥42 wk). Multivariate regression was performed to analyze the association of composite IQ scores with the number of surgeries before and after TEA.
  
  
  RESULTS
  Among 137 newborns, 25 (18.2%) had one surgery before TEA and 18 (13.1%) had ≥2 surgeries. Two or more surgeries before TEA were associated with significantly reduced composite IQ scores at 4.6 ± 0.6 y after adjusting for gestational age and illness severity. Neither the number of surgeries after TEA nor sedation for MRI was associated with cognitive outcome.
  
  
  CONCLUSIONS
  More than one surgery prior to TEA is independently associated with impaired cognitive performance in premature newborns.
authors.affiliation: Department of Pediatrics, University of California-San Francisco, San Francisco, California.
authors.forename: Dawn
authors.initials: D
authors.lastname: Gano
authors.affiliation: Department of Medicine, Queens University, Kingston, Ontario, Canada.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Andersen
authors.affiliation: 1] Department of Pediatrics, University of California-San Francisco, San Francisco, California [2] Department of Neurology, University of California, San Francisco, San Francisco, California.
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Glass
authors.affiliation: Department of Pediatrics, University of California-San Francisco, San Francisco, California.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Rogers
authors.affiliation: Department of Epidemiology & Biostatistics, University of California-San Francisco, San Francisco, California.
authors.forename: David V
authors.initials: DV
authors.lastname: Glidden
authors.affiliation: 1] Department of Pediatrics, University of California-San Francisco, San Francisco, California [2] Department of Neurology, University of California, San Francisco, San Francisco, California [3] Department of Radiology, University of California-San Francisco, San Francisco, California.
authors.forename: A James
authors.initials: AJ
authors.lastname: Barkovich
authors.affiliation: 1] Department of Pediatrics, University of California-San Francisco, San Francisco, California [2] Department of Neurology, University of California, San Francisco, San Francisco, California.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Ferriero
mesh_terms: D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D001921:Brain / Q000601:surgery*; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007361:Intelligence Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D012044:Regression Analysis; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods