Motor and cognitive outcome at school age of children with surgically treated intestinal obstructions in the neonatal period
Introduction
An intestinal obstruction is a gastrointestinal complication that leads to impaired bowel passage. It occurs in approximately 9 out of every 10,000 newborn infants [1], [2]. It can be caused by congenital malformations of the intestine such as an intestinal atresia or stenosis, or by a malrotation of the intestine. Infants who present with such an obstruction often require surgery in the neonatal period to remove the obstruction, promote normal bowel function and allow oral feeding.
During the neonatal period, a period of rapid cerebral growth, major surgery and anesthesia is associated with developmental delay at 1 to 2 years [3]. Specific groups at risk are preterm infants [4], [5], infants undergoing cardiac surgery [6], and term infants undergoing noncardiac surgery for a variety of congenital anomalies such as intestinal atresias, esophageal atresia, congenital diaphragmatic hernia, and hypertrophic pyloric stenosis [6]. Potentially harmful factors include physiological stress occurring during surgery [7], anesthesia-induced apoptosis of developing neurons [8], the nature of the underlying congenital anomaly [3], [6], and the surgical procedure in itself, whether it consists for example of resection of the ileocoecal valve or the creation of an ostomy [9].
Although these factors are recognized risk factors for adverse neurodevelopmental outcome, the motor and cognitive outcome at school age of newborn infants with surgically treated intestinal obstructions is unknown. Our main aim was therefore to determine the outcome of such infants by assessing their motor and cognitive performance at school age. Motor and cognitive outcomes measured at school age are known to be more robust and predictive for later life than outcomes measured at pre-school age. Our secondary aim was to explore which clinical factors were associated with adverse outcome.
Section snippets
Patients
We selected all infants who had been admitted to the Neonatal Intensive Care Unit of the University Medical Center Groningen between 1995 and 2002, and who were diagnosed by laparotomy with duodenal, jejunal, ileal or colon atresia, intestinal stenosis, or a malrotation of the intestine. We excluded patients with major chromosomal and congenital anomalies other than single atresias or stenoses.
Follow-up
The children were invited prospectively to participate in this follow-up study, which was an extension
Patient characteristics
A database search resulted in 44 children who met our inclusion criteria, three (7%) of them had died in the neonatal period. Twenty-seven (66%) out of the 41 survivors were included in the follow-up study. The parents of seven children declined the invitation to participate; the parents of all of these children reported that their child attended formal education and did not encounter any neurological or behavioral problems. Seven other children could not be traced. Table 1 shows the patient
Discussion
This study showed that at school age more than twenty percent of children with surgically treated intestinal obstructions in the neonatal period had abnormal motor functioning and fifteen percent had abnormal selective attention. This was significantly more than the norm population. Intelligence, visual perception, visuomotor integration, and verbal memory were not affected. Low birth weight, IUGR, and the presence of an intestinal perforation were risk factors for adverse outcomes in infants
Conclusion
The identification of patients with intestinal obstruction being at highest risk for developmental impairments is an important issue, with potential consequences for future organization of long-term follow up programs. This study demonstrates that children with intestinal obstructions surgically treated in the neonatal period showed abnormal motor functioning and abnormal selective attention at school age compared to the norm population. Intelligence, visual perception, visuomotor integration,
Conflict of interest
All authors declare that they have nothing to disclose, financially or otherwise. There is no conflict of interest. This study was not the result of a clinical trial. No study sponsor was involved. The first draft of the manuscript was written by R.M. Elsinga. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.
References (27)
- et al.
Neurologic outcomes in very preterm infants undergoing surgery
J Pediatr
(2012) Effect of general anesthesia on the developing brain
J Anaesthesiol Clin Pharmacol
(2012)- et al.
Performance of 225 Dutch school children on Rey's Auditory Verbal Learning Test (AVLT): parallel test–retest reliabilities with an interval of 3 months and normative data
Arch Clin Neuropsychol
(1999) Postnatal sepsis, necrotizing entercolitis, and the critical role of systemic inflammation in white matter injury in premature infants
J Pediatr
(2008)Disorders of the intestines and pancreas
- et al.
Intestinal atresia and stenosis: a 25-year experience with 277 cases
Arch Surg
(1998) - et al.
Developmental outcomes following major surgery: what does the literature say?
J Paediatr Child Health
(2011) - et al.
Functional impairments at school age of children with necrotizing enterocolitis or spontaneous intestinal perforation
Pediatr Res
(2011) - et al.
Early developmental outcomes following major noncardiac and cardiac surgery in term infants: a population-based study
J Pediatr
(2012) - et al.
Hormonal stress responses in neonates undergoing cardiac surgery
Anesthesiology
(1990)
Ostomy creation in neonates with acute abdominal disease: friend or foe?
Eur J Pediatr Surg
Movement Assessment Battery for Children
WISC-III NL Handleiding
Cited by (14)
Childhood Educational Outcomes of Children Born with Gastroschisis
2022, Journal of PediatricsBody composition and cognition in preschool-age children with congenital gastrointestinal anomalies
2019, Early Human DevelopmentCitation Excerpt :Although the potential early differences in growth were no longer present at preschool-age, brain growth and resulting brain function may still be impacted by early stress, inflammation, and inadequate nutrition. Several studies have described lasting neurodevelopmental delays in children requiring neonatal surgery including deficits in cognition [29,30], receptive language/verbal intelligence [29–31] executive function [32], working memory [33], attention [31,34], gross motor skills [29,34], and fine motor skills [30,31]. Perhaps one of the most thorough longitudinal studies involving a patient population similar to our cohort was conducted by Ludman et al. [7,35,36].
More than 3 hours and less than 3 years old. Safety of anesthetic procedures in children under 3 years of age, subject to surgeries of more than 3 hours
2017, Revista Espanola de Anestesiologia y ReanimacionFunctional outcome at school age of children born with gastroschisis
2017, Early Human DevelopmentCitation Excerpt :Repeated surgical procedures are often required. Such events in early life may affect neurodevelopment [3]. The majority of gastroschisis children are born preterm (60%) [4] and up to 61% is born small for gestational age (SGA) [5–7].
Anesthesia for General Surgery in the Neonate
2016, Smith's Anesthesia for Infants and Children, Ninth Edition