The influence of prematurity on neonatal surgical morbidity and mortality

Nicholas J. Skertich, Martha Conley E. Ingram, Ethan Ritz, Ami N. Shah, Mehul V. Raval*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: As survival rates amongst premature infants have improved, prematurity remains a leading contributor to neonatal surgical morbidity and mortality. This study aims to better assess the influence of prematurity on surgical outcomes. Methods: The NSQIP-Pediatric database was used to compare outcomes between preterm and term infants undergoing surgical repair of select congenital anomalies from 2012 to 2017. Prematurity was categorized as extremely preterm (EP) (< 29 weeks), very preterm (VP) (29–32 weeks), moderate to late preterm (MLP) (33–36 weeks), and term (≥ 37 weeks). Significance was determined using Chi-square tests, Fisher exact tests and adjusted logistic regression analysis. Results: 4852 infants were identified with 45 (0.9%) EP, 211 (4.3%) VP, 1492 (30.8%) MLP, and 3104 (64.0%) term. Compared to term, preterm infants have increased odds of surgical morbidity (EP Odds Ratio (OR) 3.2 95% Confidence Interval (CI) 1.6–6.4, VP OR 1.2 95%CI 0.9–1.7, and MLP OR 1.2 95%CI 1.0–1.4). 30-day mortality decreased as neonatal age increased from 22.2% EP to 2.9% term (p < 0.001). Premature populations had higher rates of sepsis, pneumonia, bleeding requiring transfusion and 30-day mortality. Conclusions: Prematurity increases morbidity and mortality amongst neonates undergoing surgery. Risk-adjustment for prematurity is needed and premature infants may have unique quality improvement targets. Level of Evidence: Level III.

Original languageEnglish (US)
Pages (from-to)2608-2613
Number of pages6
JournalJournal of pediatric surgery
Issue number12
StatePublished - Dec 2020


  • Complications
  • Congenital anomalies
  • Pediatric surgery
  • Prematurity

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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