The Impact of Surgical Intervention on Neurodevelopmental Outcomes in Very Low Birth Weight Infants: a Nationwide Cohort Study in Korea

• Published in: Journal of Korean medical science Vol. 34; no. 43; pp. e271 - 10
• Main Authors: Sung, Se In, Lee, Na Hyun, Kim, Hyun Ho, Kim, Hye Seon, Han, Yea Seul, Yang, Misun, Ahn, So Yoon, Chang, Yun Sil, Park, Won Soon
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 11.11.2019; 대한의학회
• Subjects: Cohort Studies; Databases, Factual; Ductus Arteriosus, Patent - surgery; Female; Gestational Age; Hospital Mortality; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Intestinal Perforation - surgery; Male; Multivariate Analysis; Neurodevelopmental Disorders - diagnosis; Neurodevelopmental Disorders - etiology; Odds Ratio; Original; Registries; Republic of Korea; Risk Factors; Surgical Procedures, Operative - adverse effects; 의학일반; Republic of Korea; Very Low Birth Weight Infant; Neurodevelopmental Outcome; Surgery; Korean Neonatal Network
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2019.34.e271

To investigate the incidence of surgical intervention in very low birth weight (VLBW) infants and the impact of surgery on neurodevelopmental outcomes at corrected ages (CAs) of 18-24 months, using data from the Korean Neonatal Network (KNN). Data from 7,885 VLBW infants who were born and registered with the KNN between 2013 to 2016 were analyzed in this study. The incidences of various surgical interventions and related morbidities were analyzed. Long-term neurodevelopmental outcomes at CAs of 18-24 months were compared between infants (born during 2013 to 2015, n = 3,777) with and without surgery. A total of 1,509 out of 7,885 (19.1%) infants received surgical interventions during neonatal intensive care unit (NICU) hospitalization. Surgical ligation of patent ductus arteriosus (n = 840) was most frequently performed, followed by laser therapy for retinopathy of prematurity and laparotomy due to intestinal perforation. Infants who underwent surgery had higher mortality rates and greater neurodevelopmental impairment than infants who did not undergo surgery ( value < 0.01, both). On multivariate analysis, single or multiple surgeries increased the risk of neurodevelopmental impairment compared to no surgery with adjusted odds ratios (ORs) of 1.6 with 95% confidence interval (CI) of 1.1-2.6 and 2.3 with 95% CI of 1.1-4.9. Approximately one fifth of VLBW infants underwent one or more surgical interventions during NICU hospitalization. The impact of surgical intervention on long-term neurodevelopmental outcomes was sustained over a follow-up of CA 18-24 months. Infants with multiple surgeries had an increased risk of neurodevelopmental impairment compared to infants with single surgeries or no surgeries after adjustment for possible confounders.