Aim Children with congenital gastrointestinal malformations may be at risk of neurodevelopmental impairment due to challenges to the developing brain, including perioperative haemodynamic changes, exposure to anaesthetics and postoperative inflammatory influences. This study aggregates existing evidence on neurodevelopmental outcome in these patients using meta-analysis. Method PubMed, Embase and Web of Science were searched for peer-reviewed articles published until October 2019. Out of the 5316 unique articles that were identified, 47 studies met the inclusion criteria and were included. Standardised mean differences (Cohen’s d) between cognitive, motor and language outcome of patients with congenital gastrointestinal malformations and normative data (39 studies) or the studies’ control group (8 studies) were aggregated across studies using random-effects meta-analysis. The value of (clinical) moderators was studied using meta-regression and diagnostic subgroups were compared. Results The 47 included studies encompassed 62 cohorts, representing 2312 patients. Children with congenital gastrointestinal malformations had small-sized cognitive impairment (d=−0.435, p<0.001; 95% CI −0.567 to −0.302), medium-sized motor impairment (d=−0.610, p<0.001; 95% CI −0.769 to −0.451) and medium-sized language impairment (d=−0.670, p<0.001; 95% CI −0.914 to −0.425). Patients with short bowel syndrome had worse motor outcome. Neurodevelopmental outcome was related to the number of surgeries and length of total hospital stay, while no relations were observed with gestational age, birth weight, age and sex. Interpretation This study shows that children with congenital gastrointestinal malformations exhibit impairments in neurodevelopmental outcome, highlighting the need for routine screening of neurodevelopment during follow-up. Data are available upon reasonable request.

中文翻译：

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先天性胃肠道畸形患者的神经发育结局：系统评价和荟萃分析


目的 患有先天性胃肠道畸形的儿童可能因大脑发育受到挑战而面临神经发育障碍的风险，包括围手术期血流动力学变化、麻醉剂暴露和术后炎症影响。这项研究利用荟萃分析汇总了这些患者神经发育结果的现有证据。 Method PubMed、Embase 和 Web of Science 搜索了截至 2019 年 10 月发表的同行评审文章。在确定的 5316 篇独特文章中，有 47 项研究符合纳入标准并被纳入。使用随机效应荟萃分析，对先天性胃肠道畸形患者的认知、运动和语言结果与规范数据（39 项研究）或研究对照组（8 项研究）之间的标准化平均差异（Cohen's d）进行汇总。使用荟萃回归研究（临床）调节因素的价值，并比较诊断亚组。结果 47 项纳入研究涵盖 62 个队列，代表 2312 名患者。先天性胃肠道畸形儿童有小型认知障碍（d=-0.435，p<0.001；95% CI -0.567至-0.302），中型运动障碍（d=-0.610，p<0.001；95% CI - 0.769 至 -0.451）和中度语言障碍（d=-0.670，p<0.001；95% CI -0.914 至 -0.425）。短肠综合征患者的运动结果较差。神经发育结果与手术次数和总住院时间有关，而与胎龄、出生体重、年龄和性别没有关系。 解释 这项研究表明，患有先天性胃肠道畸形的儿童表现出神经发育结果受损，强调了在随访期间对神经发育进行常规筛查的必要性。数据可根据合理要求提供。