Neonatal Surgery for Noncardiac Congenital Anomalies: Neonates at Risk of Brain Injury.
OBJECTIVE
To evaluate the incidence of brain injury after neonatal surgery for noncardiac congenital anomalies using magnetic resonance imaging (MRI).


STUDY DESIGN
An MRI was obtained in 101 infants at 7 days [range: 1-115] after neonatal surgery for major noncardiac congenital anomalies. Brain injury was assessed using T1, T2, diffusion weighted imaging, and susceptibility-weighted imaging.


RESULTS
Thirty-two preterm infants (<37 weeks of gestation) and 69 full-term infants were included. MRI abnormalities were found in 24 (75%) preterm and 40 (58%) full-term infants. Parenchymal lesions were noted in 23 preterm (72%) and 29 full-term infants (42%). These consisted of punctate white matter lesions (n = 45), punctate cerebellar lesions (n = 17), thalamic infarction (n = 5), and periventricular hemorrhagic infarction (n = 4). Nonparenchymal abnormalities were found in 9 (28%) preterm and 26 (38%) full-term infants. These included supra- and infratentorial subdural hemorrhages (n = 30), intraventricular hemorrhage grade II (n = 7), and asymptomatic sinovenous thrombosis (n = 1). A combination of parenchymal lesions was present in 21 infants. Of infants who had an MRI within 10 days after surgery, punctate white matter lesions were visible on diffusion weighted imaging in 22 (61%), suggestive of recent ischemic origin. Type of congenital anomaly and prematurity were most predictive of brain injury.


CONCLUSIONS
Infants who have neonatal surgery for noncardiac congenital anomalies are at risk of brain injury, potentially accounting for the neurodevelopmental delay frequently observed in this population. Further research is warranted into potential mechanisms of brain injury and its timing of onset. Long-term neurodevelopmental follow-up is needed in this vulnerable population.
['Stolwijk|Lisanne J|LJ|', 'Keunen|Kristin|K|', 'de Vries|Linda S|LS|', 'Groenendaal|Floris|F|', 'van der Zee|David C|DC|', 'van Herwaarden|Maud Y A|MYA|', 'Lemmers|Petra M A|PMA|', 'Benders|Manon J N L|MJNL|']
D001930:Brain Injuries D015331:Cohort Studies D000013:Congenital Abnormalities D038524:Diffusion Magnetic Resonance Imaging D005260:Female D017052:Hospital Mortality D006801:Humans D007231:Infant, Newborn D007234:Infant, Premature D008297:Male D011183:Postoperative Complications D011237:Predictive Value of Tests D012189:Retrospective Studies D018570:Risk Assessment D018709:Statistics, Nonparametric D013514:Surgical Procedures, Operative D016019:Survival Analysis D047929:Term Birth D016896:Treatment Outcome
brain injury MRI