Elsevier

Journal of Pediatric Surgery

Volume 46, Issue 12, December 2011, Pages 2250-2253
Journal of Pediatric Surgery

PAPS paper
Psychosocial and cognitive consequences of major neonatal surgery

https://doi.org/10.1016/j.jpedsurg.2011.09.006Get rights and content

Abstract

Purpose

To evaluate the long-term quality of life (QOL) of patients who had undergone major neonatal surgery, the psychosocial and cognitive consequences of neonatal surgical stress were assessed when the patients reached school age.

Materials and methods

Seventy-two patients who had undergone major neonatal surgery were enrolled in this study. Their primary diseases were anorectal malformation (ARM) in 27 cases, esophageal atresia (EA) in 23, and congenital diaphragmatic hernia (CDH) in 22. Intelligence tests using Wechsler Intelligence Scale for Children III (WISC-III) or a developmental test and the Child Behavior Checklist were conducted through questionnaires and interviews with clinical psychologists.

Results

Mental retardation (MR) was apparent in 25% of EA, 20% of ARM, and 18% of CDH, significantly higher than the 2% to 3% commonly found in the general population. The clinical range (CR) of the Child Behavior Checklist was seen in 35% of EA, 59% of ARM, and 38% of CDH, which is also significantly higher than the 25% typically seen in the general population. No significant differences in MR and CR were seen among the primary diseases. The most important factors influencing MR and CR remain to be identified.

Conclusions

To ensure true quality of life after neonatal surgical stress, pediatric surgeons must consider not only physical assessments but also cognitive, emotional, and psychosocial assessments.

Section snippets

Material and methods

Seventy-two pediatric patients above school age, 37 males and 35 females, all of whom had undergone major surgery during the neonatal period or in early infancy, were enrolled in this study. Their ages ranged between 6 and 17 years. The subjects of the study included the most typical neonatal surgical diseases requiring long-term follow-up: esophageal atresia (EA) in 23 cases, high and intermediate types of ARM in 27, and congenital diaphragmatic hernia (CDH) in 22. The index patients were

Results

Mental retardation was recognized in 14 cases in total (67): 5 cases of EA (20), 5 of ARM (25), and 4 of CDH (22) (Table 1). Although the incidence of MR did not differ among the primary diseases, that in each study group was significantly higher than the 2% to 3% commonly found in the general population [10], [11]. Mental retardation was recognized in 4 cases of Gr. S (34) and in 10 cases of Gr. L (33), for an incidence of 12% and 30%, respectively. The incidence of MR in Gr. L was higher than

Discussion

We pediatric surgeons sometimes notice that patients who have undergone major surgery during the neonatal period or in early infancy have emotional disturbances or interpersonal-relationship disorders. Unlike neurologically impaired patients, however, these conditions are not recognized as a consequence of neonatal surgical stress or as being secondary to the diseases per se, and they are not considered for treatment or handled as disorders. To determine the actual incidence of psychosocial and

References (14)

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    Children with HSCR avoided foods to manage their bowel habits, missed more school, and experienced more embarrassment and discomfort [2]. Absences caused by ongoing bowel management issues and medical procedures decreased time for regular peer interaction and contributed to poor school performances [2,5,17–21]. In Honduras, 50% of interviewed patients who had a colostomy quit school at an early age due to bullying and peer rejection [22].

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    Of the latter, 26 articles were prospective [3,7,13,14,22,27,31,34,44,46,53–55,57,58,62,63,67,69,72,74,80,83,84,86,88] and 44 were designed to address neurodevelopmental outcome and/or neuroimaging abnormalities in CDH survivors [5,23,24,27–30,32,37–46,48,49,51,53–56,58–63,65,67,71,72,78–84,86,87]. Out of 3541 children with CDH (33 studies), 829 (23%, range 6%–60%) were reported to have NDI (Table 2) [3,5,7,13,21,23,25,26,29,31,34,36,39–41,47,50,52,53,55,61,62,64,68–70,72,73,76,78,83,87,88]. The mean age at NDI assessment varied strongly in these studies as reported in Table 2.

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    The Swedish school law ensures the provision of special preschool/school support to children in need [17], and using the total number of study participants in preschool/school benefited the statistical analysis of clinical predictors in agreement with statistical expertise. The need to understand psychosocial consequences after major neonatal surgery has been pointed out [9,11]. This study brings new information to the field.

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Presented at the Pacific Association of Pediatric Surgeons 44th Annual Meeting, Cancun, Mexico, April 10-14, 2011.

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