SURGERY AND THE TINY BABY - SENSORINEURAL OUTCOME AT 5 YEARS OF AGE

Objective: To determine whether an association exists between long-ter m sensorineural outcome and the need for surgery requiring general ana esthesia during the primary hospitalization in extremely preterm (<27 weeks of gestational age) or extremely low birthweight (ELBW, birthwei ght <1000 g) infants. Methodology: A geographically determined cohort study of extremely preterm or ELBW children in the State of Victoria, Australia. The study subjects were consecutive survivors with either g estational ages <27 weeks or birthweights <1000 g born in the State of Victoria during 3 years from 1 January 1985. The main outcome measure was the rate of sensorineural disability at 5 or more years of age in relation to surgical procedures requiring general anaesthesia perform ed during the primary hospitalization. Results: Of 221 children surviv ing to 5 years of age, 54 (24.4%) had at least one surgical operation requiring general anaesthesia during their primary hospitalization. Th e operations included the following: (i) ligation of ductus arteriosus (n = 26); (ii) inguinal hernia repair (n = 16); (iii) central nervous system surgery (n = 4); (iv) gastrointestinal surgery (n = 5); and (v ) tracheostomy or bronchoscopy (n = 5). Of the 221 survivors to 5 year s of age, 218 (98.6%) were assessed for sensorineural impairments and disabilities. Of the 53 children who were assessed at 5 or more years of age and who had had surgery, 7 (13.2%) were severely disabled, 8 (1 5.1%) were moderately disabled, 12 (22.6%) were mildly disabled, and 2 6 (49.1%) were non-disabled. The overall rate of sensorineural disabil ity was significantly higher in children who had been operated on comp ared with those who had not (Mann-Whitney U-test, z = 3.7, P<0.001). C onclusions: There is an adverse association between the need for surge ry requiring general anaesthesia during the primary hospitalization an d sensorineural outcome in extremely preterm or ELBW infants.