Original article
Interdisciplinary structural follow-up of surgical newborns: a prospective evaluation

https://doi.org/10.1016/j.jpedsurg.2008.12.034Get rights and content

Abstract

Background

Information on physical and developmental outcomes of children with anatomical congenital anomalies (CAs) may indicate the need for early intervention and reduce impact on the child's life and parental burden.

Methods

From 1999 to 2003, 101 children with CA (76.5% of initial survivors) were seen 6-monthly in a tertiary children's hospital. Growth, neurologic outcome, mental and psychomotor development as determined with the Bayley Scales of Infant Development, and categorization of predictive sociodemographic and medical variables of the children were evaluated prospectively and longitudinally.

Results

Congenital diaphragmatic hernia (CDH) and esophageal atresia patients showed impaired growth, that is, both height for age (−1.5 standard deviation score [SDS]) and weight for height (−1.0 SDS). Overall neurologic outcome was normal, however, suspect or abnormal for 40% of CDH patients. Overall mental development was normal, but psychomotor scores were significantly lower than the norm (95% confidence interval, 83.8-92.2 at 6 months and 87.9-98.5 at 24 months). Sex, maternal age, socioeconomic status, CA, severity-of-disease covariables, and need of medical appliances at home could predict negative outcome significantly (P < .05).

Conclusions

The CA survivors show impaired growth and psychomotor developmental delay up to age 2 years. This warrants specific follow-up programs and infrastructure for these patients.

Section snippets

Design

This is an observational, prospective, longitudinal cohort study consisting of repeated measurements at 6, 12, 18, and 24 months.

Setting

The pediatric surgical department of our institution is a large tertiary facility in which all major surgical specialties are represented. The referral area has 4 million inhabitants with 44,000 newborns annually.

In 1999, a follow-up program was started, run by a team of pediatricians, psychologists, a physiotherapist, nurses, a social worker, a clinical geneticist,

Results

The children's medical and sociodemographic characteristics at first discharge are presented in Table 1. We distinguished the following 6 aforementioned categories: AWD (n = 19); CDH (n = 18); SIA such as duodenal atresia, malrotation, and volvulus (n = 34); EA (n = 17); ARM (n = 6); and HD (n = 7). It turned out no statistical analyses could be performed on the combined ARMs and HD group because of small numbers. Moreover, their characteristics were such that we felt they were not

Discussion

This study shows that surgical newborns had impaired growth and developmental delay, mainly with respect to psychomotor development within the first 2 years of life. Factors indicative for severity of disease have a negative influence on mental and psychomotor developmental outcome. Number of CA as well as duration of admission and number of surgical interventions proved to be significant determinants of mental and psychomotor outcome.

Because we aimed at focusing solely on the effect of CA,

Acknowledgment

We thank Ko Hagoort for patiently editing the article.

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      Following the establishment of the first multidisciplinary CDH clinic at Boston Children's Hospital in 1990, other pediatric institutions have established similar clinics, expanding our understanding of CDH and improving perioperative care as well as long term outcomes [7,8]. Long-term follow-up of CDH survivors has helped us understand associated comorbidities including gastrointestinal (GI) sequelae, cardiopulmonary disease, neurological impairment, and musculoskeletal anomalies [8,9]. Our institution is a high volume CDH center with a long-term multidisciplinary CDH clinic established over 15 years ago, providing vast data to improve our understanding of long-term outcomes in this patient population.

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    This study was funded by the Erasmus Medical Center and the Department of Pediatric Surgery. Funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the paper for publication.

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