BACKGROUND: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). METHODS: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. RESULTS: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 (P 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. CONCLUSION: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.

译文

背景:使用韩国新生儿网络(KNN)的数据,调查极低出生体重(VLBW)婴儿的外科手术发生率以及18个月至24个月校正年龄(CA)手术对神经发育结局的影响。
方法:本研究分析了2013年至2016年间在KNN出生和登记的7885名VLBW婴儿的数据。分析了各种外科手术的发生率和相关的发病率。比较了有手术和无手术的婴儿(2013年至2015年出生,n = 3,777)在18-24个月CA时的长期神经发育结局。
结果:在新生儿重症监护病房(NICU)住院期间,共有7,885例婴儿中的1,509例接受了手术干预。外科手术治疗动脉导管未闭(n = 840),然后进行激光治疗以治疗由于视网膜穿孔而导致的早产儿视网膜病变和剖腹手术。与未接受手术的婴儿相比,接受手术的婴儿死亡率更高,神经发育障碍更大(P值均<0.01)。在多变量分析中,与未进行手术的患者相比,单次或多次手术增加了神经发育障碍的风险,调整后的优势比(OR)为1.6,95%置信区间(CI)为1.1-2.6,2.3为95%CI为1.1-4.9。
结论:在新生儿重症监护病房住院期间,大约五分之一的VLBW婴儿接受了一项或多项外科手术。在CA 18-24个月的随访中,外科手术对长期神经发育结局的影响得以持续。与仅进行一次手术或未进行可能的混杂因素调整后不进行任何手术的婴儿相比,进行多次手术的婴儿神经发育受损的风险增加。

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