Preterm Surgeries May Impair Later Cognition

Authors: Gano D et al., Pediatr Res 2015 Sep 78:323

A significant reduction in composite IQ scores was found at age 3 to 6 years when preterm infants had two or more surgeries before term-equivalent age.

There has been growing concern about potential adverse effects of general anesthesia on the developing brain. In a prospective cohort study of infants born before 33 weeks gestational age, researchers evaluated the effect of preterm anesthesia exposure on neurodevelopment at ages 3 to 6 years.

Of 137 participants, 25 had one surgery before term-equivalent age (TEA) and 18 had two or more pre-TEA surgeries. Mean age at follow-up was 4.6 years. Compared with no pre-TEA surgery, more than one surgery was associated with decreased full-scale IQ, and two or more surgeries were associated with reduced performance and verbal IQ. In analyses corrected for potential confounders (gestational age, prenatal use of corticosteroids, selected neonatal complications, patent ductus arteriosus, white matter injury, number of postnatal surgeries, and magnetic resonance imaging with sedation), two or more pre-TEA surgeries were independently associated with reduced full-scale IQ (mean reduction, 20.3 points), performance IQ (mean reduction, 22.7 points), and verbal IQ (mean reduction, 12.7 points). In adjusted analyses, there was no association between the number of pre-TEA surgeries and an abnormal postnatal neurological examination.

Comment

Two or more general anesthesia exposures before TEA in small premature infants are associated with reductions in IQ scores during early development. A growing body of evidence supports careful scrutiny of when (and whether) to consider early neonatal surgical procedures and discussing the potential risks with parents.