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Early surgery in very preterm infants is associated with brain abnormalities on term MRI: a propensity score analysis



To investigate the association between exposure to surgery under general anesthesia and brain abnormalities and neurodevelopmental outcomes in very preterm infants.

Study design

This prospective observational study includes 392 infants born at or below 32 weeks' gestational age. Participants completed brain MRI at term-equivalent age and Bayley-III assessment at 2 years corrected age. We evaluated the independent effects of surgery on brain MRI abnormalities and neurodevelopmental outcomes after propensity score matching.


All infants completed brain MRI, and 341 (87%) completed neurodevelopmental testing. Forty-five received surgery. Surgery was associated with worse MRI abnormalities (p < 0.0001) but with none of the developmental outcomes after propensity score matching. The global brain abnormality score was associated with the Bayley Cognitive (p = 0.005) and Motor (p = 0.028) composite scores.


Very preterm infants exposed to surgery under general anesthesia were at higher risk of brain abnormalities on MRI at term.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


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We sincerely thank the parents of infants that participated in our study and the Cincinnati Infant Neurodevelopment Early Prediction Study (CINEPS) Investigators. We also greatly appreciate the support of our NICU fellows, nurses, and staff, and most importantly, all the study families that made this research possible.


Supported by the National Institutes of Health from the National Institute of Neurological Disorders and Stroke (R01-NS094200, R01-NS096037, and R01-EB029944) to NAP and from the National Center for Advancing Translational Sciences (2UL1TR001425-05A1) to KK.

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Authors and Affiliations



KK analyzed and interpreted data and cowrote the article. CL and SE analyzed and interpreted data and were involved in critical revisions. BMKF and SJ collected data and were involved in critical revisions. NAP designed the study, analyzed, and interpreted data, and cowrote the article.

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Correspondence to Nehal A. Parikh.

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Kojima, K., Liu, C., Ehrlich, S. et al. Early surgery in very preterm infants is associated with brain abnormalities on term MRI: a propensity score analysis. J Perinatol (2023).

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