European Journal of Cardiovascular Medicine

Neonatal surgery is a critical intervention aimed at treating life-threatening conditions in newborns, such as congenital heart defects, gastrointestinal anomalies, or diaphragmatic hernias1,2. These procedures are essential for survival and improving the quality of life in affected infants. However, despite the immediate benefits of neonatal surgery, there is growing concern about the long-term consequences it may have on the child's development and mental health3,4.

The early years of a child's life are marked by rapid physical, cognitive, and emotional development. Any disruption during this period, including the physical and psychological stress associated with surgery, has the potential to affect these developmental milestones5. Previous research has primarily focused on the immediate survival outcomes and post-operative recovery of neonates undergoing surgery. However, less attention has been paid to the longer-term impact of neonatal surgery on the development of psychiatric disorders and developmental delays6,7.

Developmental delays encompass a wide range of conditions, including delays in motor skills, language acquisition, and cognitive function, which may manifest in early childhood. Similarly, psychiatric disorders such as anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) are increasingly being recognized as significant health concerns in young children, particularly among those with a history of early medical interventions8,9. While some studies have suggested a potential association between neonatal surgeries and developmental outcomes, the evidence remains limited and often inconclusive.

This cohort study aims to fill this gap in the literature by examining the long-term effects of neonatal surgery on the occurrence of developmental delays and psychiatric disorders in early childhood. Specifically, this study investigates whether children who underwent neonatal surgery are at an increased risk of experiencing developmental delays at age 3 and psychiatric disorders at age 5.

Study Design
This was a prospective cohort study designed to assess the long-term developmental and psychiatric outcomes of children who underwent neonatal surgery. The study was conducted at the RVM Institute of Medical Sciences, Laxmakkapalli, Telangana, from January 2024 to December 2024. The cohort consisted of children who had undergone neonatal surgery for life-threatening conditions, and they were compared with a control group of healthy children who did not undergo any surgical intervention during the neonatal period.

Study Population
The study included two groups:

Neonatal Surgery Group: Children who underwent neonatal surgery within the first 28 days of life for life-threatening conditions, such as gastrointestinal anomalies, congenital heart defects, or other critical surgical conditions.

Control Group: Healthy children, matched by age, sex, and socioeconomic status, who were not exposed to neonatal surgery.

Both groups were selected from the patient registry at the RVM Institute of Medical Sciences. All participants were followed from birth through the age of 5 years.

Inclusion Criteria

Children aged 0-28 days who underwent neonatal surgery for life-threatening conditions.

Healthy children born at full-term, with no major medical or surgical conditions.

Parental consent for participation in the study.

Exclusion Criteria

Children with pre-existing developmental or psychiatric conditions diagnosed before the neonatal period.

Children with severe comorbidities that could influence developmental and psychiatric outcomes, such as genetic syndromes or neurological disorders.

Children whose parents did not provide informed consent.

Data Collection
Data were collected at three primary points:

Baseline (at birth):

Demographic data, including gender, gestational age, birth weight, and medical history.

Type of neonatal surgery and duration of hospital stay.

Age 3 (Developmental Assessment):

Assessment of developmental delays was conducted using standard screening tools, such as the Denver Developmental Screening Test (DDST) or the Bayley Scales of Infant and Toddler Development (BSID-III).

Specific focus on motor delays, cognitive delays, and language delays.

Age 5 (Psychiatric Assessment):

Psychiatric disorders were evaluated using age-appropriate tools such as the Child Behavior Checklist (CBCL) for children aged 5 years and the Early Childhood Inventory (ECI) for signs of anxiety and other psychiatric disorders.

Anxiety, depression, and behavioral issues were recorded with a focus on disorders like Generalized Anxiety Disorder (GAD), Attention Deficit Hyperactivity Disorder (ADHD), and oppositional defiant behaviors.

Outcome Measures
The primary outcomes were:

Developmental Delays: Defined as any delay in motor, language, or cognitive development as identified through standardized developmental screenings at age 3.

Psychiatric Disorders: Any diagnosis of psychiatric conditions, including anxiety disorders, mood disorders, or behavioral disorders, as assessed by psychiatric evaluations at age 5.

Statistical Analysis

Descriptive Statistics: Demographic characteristics of the neonatal surgery group and the control group were compared using means, standard deviations, and proportions.

Chi-square Tests: These were used to compare the prevalence of developmental delays and psychiatric disorders between the neonatal surgery and control groups.

Multivariate Regression Analysis: A multivariate logistic regression model was used to adjust for potential confounders such as gestational age, birth weight, and socioeconomic status. The odds ratios (OR) were calculated to assess the association between neonatal surgery and the risk of developmental delays and psychiatric disorders. The model was adjusted for potential confounders, including maternal age, socioeconomic status, and any other factors found to be significant in bivariate analyses.

Ethical Considerations

Informed Consent: Written informed consent was obtained from the parents or guardians of all participating children.

Confidentiality: All participant information was kept confidential, and personal identifiers were removed from all data to ensure anonymity.

Ethics Approval: The study protocol was reviewed and approved by the Institutional Review Board (IRB) at the RVM Institute of Medical Sciences.

In this cohort study, we examined the demographic characteristics, developmental delays, and psychiatric disorders among children who underwent neonatal surgery compared to a control group.

Demographic Characteristics: Table 1 presents the demographic characteristics of the study participants. There were no significant differences between the neonatal surgery group and the control group in terms of gender distribution (p = 0.72), mean gestational age (p = 0.25), or mean birth weight (p = 0.38).

Table 1: Demographic Characteristics of Study Participants

Developmental Delays at Age 3 Years: At age 3 years, children who had undergone neonatal surgery demonstrated a higher prevalence of developmental delays compared to the control group. Overall, 30% of children in the neonatal surgery group exhibited developmental delays, compared to 12% in the control group (p = 0.02). Specific developmental delays were also more prevalent in the neonatal surgery group, with 16% showing speech delay (p = 0.08), 20% showing motor delay (p = 0.04), and 10% showing cognitive delay (p = 0.15). Significant differences were observed for motor delay (p = 0.04), but not for speech or cognitive delay (Table 2).

Table 2: Developmental Delays at Age 3 Years

Psychiatric Disorders at Age 5 Years: At age 5 years, children in the neonatal surgery group had a higher incidence of psychiatric disorders than those in the control group. The prevalence of any psychiatric disorder was 20% in the neonatal surgery group, compared to 8% in the control group (p = 0.03). Anxiety disorders were more common in the neonatal surgery group (12% vs. 4%, p = 0.09), while Attention Deficit/Hyperactivity Disorder (ADHD) (p = 0.42) and depression (p = 0.53) did not differ significantly between the two groups (Table 3).

Table 3: Psychiatric Disorders at Age 5 Years

Multivariate Analysis: Multivariate analysis revealed that neonatal surgery was significantly associated with both developmental delays and psychiatric disorders. The odds of experiencing developmental delay were 2.8 times higher in the neonatal surgery group (95% CI: 1.1 - 7.2, p = 0.02), and the odds of experiencing any psychiatric disorder were 2.5 times higher (95% CI: 1.1 - 5.9, p = 0.03) (Table 4).

Table 4: Association Between Neonatal Surgery and Developmental/ Psychiatric Outcomes (Multivariate Analysis)

This cohort study provides important insights into the long-term effects of neonatal surgery on developmental and psychiatric outcomes in early childhood. The findings reveal a significant association between neonatal surgery and an increased risk of both developmental delays and psychiatric disorders. Specifically, the study demonstrates that children who undergo neonatal surgery are more likely to experience motor delays at age 3 and psychiatric disorders, including anxiety, at age 5, compared to a control group.

The higher prevalence of developmental delays in the neonatal surgery group aligns with previous studies suggesting that early life surgeries can have lasting neurodevelopmental effects. Neonatal surgery, especially when performed to correct congenital abnormalities or life-threatening conditions, may place additional stress on the developing brain. Such stressors may interfere with neuroplasticity, which is the brain's ability to adapt and reorganize itself in response to environmental challenges. The higher prevalence of motor delays (20% in the surgery group compared to 8% in the control group) supports the notion that early surgical interventions may have a specific impact on motor development, possibly due to the disruption of normal sensory-motor pathways during the critical period of neurodevelopment8.

The association between neonatal surgery and psychiatric disorders at age 5, particularly anxiety disorders, adds a new dimension to the understanding of the long-term impacts of early surgeries. Although the exact mechanisms remain unclear, it is plausible that the psychological stress of undergoing surgery, the need for extended medical care, and the potential for chronic health issues could contribute to the development of anxiety and other psychiatric disorders in early childhood. Furthermore, the potential impact of early surgery on early attachment and caregiver-child interactions may also play a role in the development of psychiatric conditions9,10. These findings echo previous research linking early life stressors to an increased risk of psychiatric disorders later in life.

The multivariate analysis confirmed the robustness of these associations, with neonatal surgery being independently associated with both developmental delays (OR = 2.8) and psychiatric disorders (OR = 2.5). These findings are consistent with earlier studies that have examined the relationship between early surgeries and later outcomes, although few have specifically focused on psychiatric disorders in early childhood11. The results suggest that the effects of neonatal surgery extend beyond the immediate medical concerns and may have broader implications for a child’s overall development and mental health.

It is important to note that while the study controls for several important demographic variables, such as gender, gestational age, and birth weight, there may still be other confounding factors that were not accounted for. These may include variations in the nature and complexity of the surgeries, the presence of additional medical complications, or differences in the socioeconomic status of families, which could influence both developmental and psychiatric outcomes. Future research should aim to address these potential confounders through more nuanced study designs, including randomized controlled trials and larger sample sizes12.

Additionally, the mechanisms through which neonatal surgery contributes to developmental and psychiatric outcomes need further exploration. Biological factors such as the impact of anesthesia on brain development, surgical trauma, or the inflammatory response to surgery might be contributing factors. Moreover, psychosocial factors, including the emotional and psychological stress experienced by both the child and the family, should also be considered in future investigations.

Given the significant associations found in this study, it is crucial that healthcare providers and caregivers closely monitor children who have undergone neonatal surgery for developmental and psychiatric concerns. Early identification and intervention can play a key role in mitigating long-term effects. Developmental assessments should be incorporated into routine follow-up care, and interventions targeting motor development and mental health should be considered if delays or disorders are detected. Additionally, counseling and support services for parents may help in managing the psychological challenges associated with raising a child who has undergone early surgery.

This study highlights the need for increased awareness of the long-term developmental and psychiatric risks associated with neonatal surgery. While surgical interventions are essential for saving lives, it is critical to understand the potential long-term implications and to provide ongoing support and monitoring for affected children. Early intervention, both for developmental delays and psychiatric disorders, could significantly improve outcomes and quality of life for these children.

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