Surgery and the tiny baby: Sensorineural outcome at 5 years of age

O bjective : To determine whether an association exists between long-term sensorineural outcome and the need for surgery requiring general anaesthesia during the primary hospitalization in extremely preterm (> 27 weeks of gestational age) or extremely low birthweight (ELBW, birthweight > 1000g) infants.
Methodology : A geographically determined cohort study of extremely preterm or ELBW children in the State of Victoria, Australia. The study subjects were consecutive survivors with either gestational ages >27 weeks or birthweights >1000g born in the State of Victoria during 3 years from 1 January 1985. The main outcome measure was the rate of sensorineural disability at 5 or more years of age in relation to surgical procedures requiring general anaesthesia performed during the primary hospitalization.
Results : Of 221 children surviving to 5 years of age, 54 (24.4%) had at least one surgical operation requiring general anaesthesia during their primary hospitalization. The operations included the following: (i) ligation of ductus arteriosus ( n = 26); (ii) inguinal hernia repair ( n = 16); (iii) central nervous system surgery ( n = 4); (iv) gastrointestinal surgery ( n = 5); and (v) tracheostomy or bronchoscopy ( n = 5). Of the 221 survivors to 5 years of age, 218 (98.6%) were assessed for sensorineural impairments and disabilities. Of the 53 children who were assessed at 5 or more years of age and who had had surgery, 7 (13.2%) were severely disabled, 8 (15.1%) were moderately disabled, 12 (22.6%) were mildly disabled, and 26 (49.1%) were non-disabled. The overall rate of sensorineural disability was significantly higher in children who had been operated on compared with those who had not (Mann-Whitney U -test, z = 3.7, P > 0.001).
Conclusions : There is an adverse association between the need for surgery requiring general anaesthesia during the primary hospitalization and sensorineural outcome in extremely preterm or ELBW infants.