Infant Perioperative Risk Factors and Adverse Brain Findings Following Long-Gap Esophageal Atresia Repair

Journal of Clinical Medicine · 6 authors, 4 centres

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TL;DR

The main limitation is the small sample size, which limits the ability to establish causation or generalize findings.

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BACKGROUND

Long-gap esophageal atresia (LGEA) repair with the Foker process involves complex perioperative care, including repeated anesthesia and prolonged sedation, which may contribute to brain vulnerability. This study aimed to explore associations between easily quantifiable clinical measures and previously reported brain MRI findings in a pilot cohort of infants following LGEA repair. Clinical measures included disease severity scores (ASA, PRAm), anesthesia exposure (number of events, cumulative MAC hours), and durations of postoperative treatments (mechanical ventilation, muscle relaxation, antibiotics, steroids, TPN). Associations were tested using Spearman rho and multivariable linear regression. Key Results: Premature infants had higher ASA scores (IV in 69%). No significant associations were found between individual clinical measures and brain MRI findings, except for a positive association between antibiotic treatment length and number of cranial MRI findings in premature infants (r=0.718, p=0.009). However, the multivariable regression model showed that clinical measures together significantly predicted the number of cranial MRI findings (F(6,14)=3.12, p=0.037), but not brain or corpus callosum volumes. Limitations: The study is a small pilot (n=13/group) with potential bias from non-uniform MRI timing, underestimation of anesthesia exposure in transferred infants, and lack of pre-treatment MRI. Causation cannot be established, and prematurity is a confounder. Implications: The findings suggest that a combination of clinical measures may serve as indirect markers for brain abnormalities following LGEA repair, highlighting the need for larger studies and long-term neurodevelopmental follow-up.

STUDY TYPE

cross-sectional

SPECIALTY

pediatrics

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ORIGINAL PAPER

PMC10003188

Infant Perioperative Risk Factors and Adverse Brain Findings Following Long-Gap Esophageal Atresia Repair

Journal of Clinical Medicine

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ABSTRACT

Recent findings implicate brain vulnerability following long-gap esophageal atresia (LGEA) repair. We explored the relationship between easily quantifiable clinical measures and previously reported brain findings in a pilot cohort of infants following LGEA repair. MRI measures (number of qualitative brain findings; normalized brain and corpus callosum volumes) were previously reported in term-born and early-to-late premature infants (n = 13/group) <1 year following LGEA repair with the Foker process. The severity of underlying disease was classified by an (1) American Society of Anesthesiologist (ASA) physical status and (2) Pediatric Risk Assessment (PRAm) scores. Additional clinical end-point measures included: anesthesia exposure (number of events; cumulative m inimal a lveolar c oncentration (MAC) exposure in hours), length (in days) of postoperative intubated sedation, paralysis, antibiotic, steroid, and total parenteral nutrition (TPN) treatment. Associations between clinical end-point measures and brain MRI data were tested using Spearman rho and multivariable linear regression. Premature infants were more critically ill per ASA scores, which showed a positive association with the number of cranial MRI findings. Clinical end-point measures together significantly predicted the number of cranial MRI findings for both term-born and premature infant groups, but none of the individual clinical measures did on their own. Listed easily quantifiable clinical end-point measures could be used together as indirect markers in assessing the risk of brain abnormalities following LGEA repair.

CITATION EXPORT

Mackenzie Shea Kagan, Jue Teresa Wang, Danielle Bennett Pier et al.. Infant Perioperative Risk Factors and Adverse Brain Findings Following Long-Gap Esophageal Atresia Repair. Journal of Clinical Medicine. (2023). https://doi.org/10.3390/jcm12051807

AUTHORS

6 · 4 CENTRES

Mackenzie Shea Kagan, Jue Teresa Wang, Danielle Bennett Pier, David Zurakowski, Russell William Jennings, Dusica Bajic

1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA
2Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
3Department of Neurology, Division of Pediatric Neurology, Massachusetts General Hospital, 55 Fruit Street, Wang 708, Boston, MA 021114, USA
4Department of Surgery, Esophageal and Airway Treatment Center, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA

EDITOR / REVIEWER

Manuel Granell Gil