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  • Systematic Review
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Brain injury and long-term outcome after neonatal surgery for non-cardiac congenital anomalies

Pediatric Research volume 94, pages 1265–1272 (2023)Cite this article

Abstract

Background

There is growing evidence that neonatal surgery for non-cardiac congenital anomalies (NCCAs) in the neonatal period adversely affects long-term neurodevelopmental outcome. However, less is known about acquired brain injury after surgery for NCCA and abnormal brain maturation leading to these impairments.

Methods

A systematic search was performed in PubMed, Embase, and The Cochrane Library on May 6, 2022 on brain injury and maturation abnormalities seen on magnetic resonance imaging (MRI) and its associations with neurodevelopment in neonates undergoing NCCA surgery the first month postpartum. Rayyan was used for article screening and ROBINS-I for risk of bias assessment. Data on the studies, infants, surgery, MRI, and outcome were extracted.

Results

Three eligible studies were included, reporting 197 infants. Brain injury was found in n = 120 (50%) patients after NCCA surgery. Sixty (30%) were diagnosed with white matter injury. Cortical folding was delayed in the majority of cases. Brain injury and delayed brain maturation was associated with a decrease in neurodevelopmental outcome at 2 years of age.

Conclusions

Surgery for NCCA was associated with high risk of brain injury and delay in maturation leading to delay in neurocognitive and motor development. However, more research is recommended for strong conclusions in this group of patients.

Impact

  • Brain injury was found in 50% of neonates who underwent NCCA surgery.

  • NCCA surgery is associated with a delay in cortical folding.

  • There is an important research gap regarding perioperative brain injury and NCCA surgery.

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Fig. 1
Fig. 2: Visualization of the results from the ROBINS-I risk of bias assessment tool.

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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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Author information

Authors and Affiliations

  1. Department of Neonatology, University Medical Center, Utrecht Brain Center and Wilhelmina Children’s Hospital, University Utrecht, Utrecht, Netherlands

    Mark Aalten, Maria Luisa Tataranno, Jeroen Dudink, Petra M. A. Lemmers & Manon J. N. L. Benders

  2. Department of Pediatric Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands

    Maud Y. A. Lindeboom

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  1. Mark Aalten
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  5. Maud Y. A. Lindeboom
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  6. Manon J. N. L. Benders
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Contributions

Each author has met the Pediatric Research authorship requirements. M.A., M.L.T., J.D., P.M.A.L., M.J.N.L.B.: substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be published. M.Y.A.L.: drafting the article or revising it critically for important intellectual content; and final approval of the version to be published.

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Correspondence to Manon J. N. L. Benders.

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Aalten, M., Tataranno, M.L., Dudink, J. et al. Brain injury and long-term outcome after neonatal surgery for non-cardiac congenital anomalies. Pediatr Res 94, 1265–1272 (2023). https://doi.org/10.1038/s41390-023-02629-8

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