Key result
ASA-PS class IV linked to ~6-fold higher 24-month mortality after noncardiac surgery.
Why the study?
Predictive models for mortality in preterm and early-term neonates were limited to the initial assessment of mortality.
What are the independent risk factors associated with mortality during the first 24 months of life in preterm and early-term neonates requiring noncardiac surgery?
Cohort (n=357)
No
What are the independent risk factors associated with mortality during the first 24 months of life in preterm and early-term neonates requiring noncardiac surgery?
ASA-PS classification, bronchodilator use, and CPR events are significant independent risk factors for 24-month mortality in preterm and early-term neonates undergoing noncardiac surgery.
Answers are grounded in this paper and cite their sources.
ASA-PS IV/V, bronchodilator use, and CPR events identify high-risk neonates; hypothesis-generating for refined risk stratification.
INTRODUCTION Predictive models for mortality in preterm/early-term neonates are limited to the initial assessment of mortality.1 This study was designed to 1) compare demographics and patient characteristics between surviving and deceased neonates born under 39 weeks of gestation requiring a noncardiac procedure and 2) identify the clinical and surgical risk associated with mortality during 24 months of life. METHODS This is a retrospective cohort study from 2013 to 2020 of 357 neonates under 39 weeks gestation with at least 24 months of postoperative follow-up admitted to Boston Children’s Hospital for a noncardiac surgical procedure. Independent risk factors for mortality were determined by multivariable Cox regression analysis. RESULTS Thirty-four (9.5%) neonates died within 24 months; 323 (91.5%) survived. Multivariable analysis revealed that American Society of Anesthesiologists Physical Status (ASA-PS) classification (adjusted hazard ratio [HR] = 6.14; 95% CI: 2.25, 16.8; P < .001, and adjusted HR = 24.8; 95% CI: 6.65, 92.9; P < .001 for ASA-PS IV and ASA-PS V, respectively) use of bronchodilators (adjusted HR = 3.42; 95% CI: 1.45, 8.07; P = .005), and the number of CPR events (adjusted HR = 5.09; 95% CI: 2.27, 11.4; P < .001, and adjusted HR = 9.96; 95% CI: 1.27, 77.9; P = .029 for 1 and 2 or more CPRs vs 0, respectively) are significant independent risk factors of mortality. CONCLUSION The mortality risk factors for neonates born under 39 weeks gestation requiring surgery collected during the first 24 months of life are sensitive to clinical changes and complications. The 3 independent risk factors include ASA-PS rating of IV or V, bronchodilator treatment, and CPR. These risk factors can be used for real-time risk stratification and to guide decisions regarding care management and targeted deployment of health care resources.
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Leahy et al. (2025) conducted a cohort in Preterm and early-term neonates requiring noncardiac surgery (n=357). ASA-PS classification IV or V, bronchodilator use, and CPR events vs. Lower ASA-PS classification, no bronchodilator use, and no CPR events was evaluated on Mortality within 24 months (HR 6.14, 95% CI 2.25-16.8, p=<.001). ASA-PS classification IV or V, bronchodilator use, and CPR events were significant independent risk factors for mortality within 24 months after noncardiac surgery.
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