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Developmental outcomes after neonatal surgery
Parents worry about the long-term effects of performing surgery on very young infants. Poorer developmental performance after cardiac surgery is well-documented, not surprising given the risk of cerebral hypoxia-ischaemia. But what about non-cardiac surgery? Authors from The Netherlands trawled the literature for studies where children with non-cardiac major congenital anomalies had been operated on up to 4 weeks post-term, and then had their development at 12 and 24 months assessed (Stolwijk L, et al. Pediatrics 2016. doi: 10.1542/peds.2015-1728). They found 23 studies involving almost 900 children. Those with known syndromic or chromosomal conditions were excluded. They were able to meta-analyse data on 500 children who had been assessed using Bayley Scales: cognitive delay was reported in 23%, with a significantly reduced mean developmental index of 92 (SD 13; p<0.001 compared to population norms). Factors increasing the risk included multiple anomalies, low birth weight and repeated surgery, but the risk remained when these were allowed for. Those with congenital diaphragmatic hernia did the worst. There was no difference between scores at 12 and 24 months, suggesting little recovery.
So is it the anaesthetic, the surgery or the condition itself? Or could it be that whatever went wrong …