Journal of Neurosurgery: Pediatrics
Volume 26: Issue 6 (Dec 2020): Pages 603-700

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Free access
Author: Nalin Gupta
Open access
Authors: Sergio Cavalheiro, Marcos Devanir Silva da Costa, Jardel Mendonça Nicácio, Patricia Alessandra Dastoli, Italo Capraro Suriano, Mauricio Mendes Barbosa, Hérbene Jose Milani, Stéphanno Gomes Pereira Sarmento, Tereza Cristina Carbonari de Faria, and Antonio Fernandes Moron

In Brief

The main objective of this study was to show the feasibility of fetal occipital encephalocele repair. The study showed that patients who underwent fetal correction of an occipital encephalocele experienced reversal of microcephaly and may have a satisfactory cognitive outcome when compared with patients treated after birth. The study opens new horizons for fetal neurosurgery.

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Authors: Danielle S. Goulding, R. Caleb Vogel, John C. Gensel, Josh M. Morganti, Arnold J. Stromberg, and Brandon A. Miller

In Brief

The objective of this study was to define the inflammatory response within the brain after intraventricular hemorrhage by using a neonatal rat model. After hemoglobin injection into the lateral ventricle, there was an acute inflammatory response, followed by oxidative stress that was concentrated in white matter. This study suggests that anti-inflammatory treatment for intraventricular hemorrhage may need to be given very early after injury in order to be effective.

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Authors: Rebecca A. Reynolds, Arnold Bhebhe, Roxanna M. Garcia, Shilin Zhao, Sandi Lam, Kachinga Sichizya, and Chevis N. Shannon

In Brief

Hydrocephalus is primarily a disease of childhood in low- and-middle-income countries. Zambia is a nation in sub-Saharan Africa of 17 million people in which over half of the population lives below the international poverty line. To date, information about neurosurgical management of pediatric hydrocephalus in Zambia has been inferred from neighboring countries since no data currently exist. The authors’ research closes that gap. This study describes pediatric hydrocephalus surgical outcomes and predictors of postoperative complications.

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Authors: Melissa A. LoPresti, Eric A. Goethe, James C. Bayley, Brandon Bertot, Peter T. Kan, and Sandi Lam
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Authors: Cameron Brimley, Vivek P. Buch, Jared M. Pisapia, and Benjamin C. Kennedy

In Brief

This paper’s objective is to demonstrate a novel innovative approach to tissue-sparing hemispherotomy in patients with intractable hemispheric epilepsy without a lateral ventricle. The surgery successfully disconnected the pathologic hemisphere and the patient has been seizure free with significant improvement in achieving developmental milestones. This technique illustrates a surgical disconnection option with low morbidity for patients who would otherwise undergo a hemispherectomy with a higher risk of significant morbidity and mortality.

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Authors: Rafael Uribe-Cardenas, Andre E. Boyke, Justin T. Schwarz, Peter F. Morgenstern, Jeffrey P. Greenfield, Theodore H. Schwartz, James T. Rutka, James Drake, and Caitlin E. Hoffman

In Brief

The authors studied the use of subdural grids for invasive monitoring in pediatric patients 3 years old and younger with refractory epilepsy. While overall complication rates were higher in this younger cohort, subdural grid placement was not associated with an increased risk of surgical complications in that population. The study is important because there is a lack of information about the utility of this technique in very young pediatric patients, its risks, and outcomes.

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Authors: Alan R. Cohen and Scellig S. D. Stone

In Brief

Intrinsic epidermoid tumors of the brainstem are rare, histologically benign lesions associated with a high surgical morbidity and mortality due to their eloquent location. The authors describe a novel technique of endoscope-assisted microsurgery for managing symptomatic lesions and recommend a strategy of conservative surgery with resection of as much of the tumor capsule as is safely possible.

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Authors: Evan D. Bander, Alexander D. Ramos, Eva Wembacher-Schroeder, Iryna Ivasyk, Rowena Thomson, Peter F. Morgenstern, and Mark M. Souweidane

In Brief

Optimizing convection-enhanced delivery (CED) for neurooncological therapeutic strategies will likely demand sequential treatments. This clinical series was intended to report on the use of multiple CED procedures and repeat dosing in children with diffuse intrinsic pontine glioma. These encouraging results related to safety, accuracy, and feasibility provide an impetus for improved clinical trial design and greater enthusiasm for device research and development.

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Authors: Thomas Larrew, Mohammed Alshareef, Robert F. Murphy, Ramin Eskandari, and Libby Kosnik Infinger

In Brief

Researchers studied if the external remote used to change magnetic growth rods used in scoliosis treatment also changed the settings of programmable shunt valves. The external programmer that changes the growth rods can change a shunt valve's settings if it is in close contact with the shunt valve. This finding brings awareness to clinicians that in patients with both types of hardware, the settings of the shunt valve should be checked after magnetic rod adjustment.

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Authors: William Fuell, Reem Elwy, Thomas Harkey, Matthew Carey, and Gregory W. Albert

In Brief

Chiari malformation type I has traditionally been defined by the amount of herniation of the cerebellar tonsils below the skull base. However, symptoms are caused by compression of the brainstem. In this paper, the authors demonstrate that the amount of tissue (cerebellum and brainstem) in the opening at the base of the skull is more predictive of the need for surgery than simply measuring the degree of herniation.

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Authors: Jordan I. Gewirtz, Alex Skidmore, Matthew D. Smyth, David D. Limbrick Jr., Manu Goyal, Joshua S. Shimony, Robert C. McKinstry, Mari L. Groves, and Jennifer M. Strahle

In Brief

The authors created an MRI spine protocol using fast sequencing to avoid sedation in pediatric patients and then assessed its use in identifying and monitoring syrinx and spinal dysraphism. They report the first pediatric series of a fast-sequence spine MRI protocol for use in young patients that does not require sedation and is able to identify and monitor syrinx and spinal dysraphism.

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Authors: Ahmed Al Menabbawy, Ehab El Refaee, Mohamed A. R. Soliman, Mohamed A. Elborady, Mohamed A. Katri, Steffen Fleck, Henry W. S. Schroeder, and Ahmed Zohdi

In Brief

The authors attempted to evaluate the effectiveness and safety of ventricular irrigation in cases of cerebral ventriculitis in a pediatric population, including using both endoscopic lavage as well as lavage with two-tube irrigation. The results showed a significance advantage of the lavage/irrigation technique over the conventional treatment methods (drainage with an external ventricular drain as well as systemic and intraventricular antibiotics) regarding survival, morbidity, and hospital stay duration. The study shows that ventricular lavage/irrigation is safe and effective in cases of cerebral ventriculitis in the pediatric population and neonates.

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Authors: Nataly Raviv, Nicholas Field, and Matthew A. Adamo

In Brief

The authors evaluated postoperative pediatric neurosurgical patients in order to determine how common postoperative fevers are and how common and helpful workups are in these patients. The authors determined that performing invasive and costly fever workups are not worthwhile in these patients in the first 4 postoperative days.

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Authors: Shunsuke Amagasa, Satoko Uematsu, and Satoshi Tsuji

In Brief

The authors’ objective was to verify intracranial injury due to short falls and examine the characteristics of these falls in infants and toddlers. In the objective classification of patients into groups based on whether or not the fall was witnessed by a nonrelative, subdural hematoma, retinal hemorrhage, and neurological sequelae due to short falls were not seen after witnessed falls. This study provided the findings in a novel way to reduce the risk of misclassification and circular reasoning.

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In Brief

The authors investigated the use of a validated instrument, the Chiari Health Index for Pediatrics (CHIP), for measuring health-related quality of life (HRQOL) in pediatric patients with Chiari malformation type I (CM-I). The CHIP instrument was effective in measuring postoperative changes and effectively captured significant improvements in patient HRQOL as well as symptomatology after surgical decompression. Widespread use of this questionnaire can offer physicians more insight into the impact of CM-I on HRQOL, which may guide a more holistic approach to care.

Free access

In Brief

The authors developed an artificial intelligence tool to consistently and objectively measure cerebral ventricular volume, over time, for patients with hydrocephalus. This clinical tool is reliable across different institutional scanners as well as small variations in slice thickness and head angulation. It is faster and more accurate than currently available research tools and will serve as a useful clinical adjunct to standardize and improve patient care.

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In Brief

Investigators applied a screening tool to estimate the proportion of children evaluated at an epilepsy referral clinic that may be considered for epilepsy surgery in Haiti. Of the subset of children who underwent imaging, a majority met criteria for surgical evaluation. This work suggests that children with epilepsy in Haiti could benefit from being evaluated at a center with the capacity to perform basic brain imaging and neurosurgical treatments.

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In Brief

The objective of the study was to evaluate a relatively novel brain target of deep brain stimulation surgery for acquired dystonia in a rigorous scientific fashion to set the stage for future larger controlled trials. The key finding was that bilateral thalamic neuromodulation for severe acquired dystonia in children and young adults was well tolerated, and that while improvements in quality of life and disability were noticed, these were not fully captured in usual disease severity rating scales. This study adds value by expanding the knowledge of potential brain targets in pediatric patients with severe acquired medication-refractory dystonia.

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In Brief

Enhanced recovery after surgery protocols have gained a significant foothold in adult general surgery populations for their ability to improve outcomes and reduce costs. In this study the authors systematically review the application of enhanced recovery after surgery protocols to pediatric scoliosis populations and find that these protocols may shorten hospitalizations, reduce complication rates, and reduce postoperative pain. This is the first quantitative analysis of the pediatric enhanced recovery after surgery literature, and it highlights the need for additional, high-quality studies.

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In Brief

The objective of this paper was to document the largest available series of pediatric patients with skull base chordomas undergoing endoscopic endonasal resection. Endoscopic endonasal resection was associated with a high rate of tumor control and a low rate of permanent neurological deficits. The authors demonstrate the feasibility, value, and complications associated with adding endoscopic endonasal resection to the treatment armamentarium for pediatric chordomas of the skull base. The findings also suggest that pediatric chordomas are not, as a whole, as aggressive as previously thought.

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In Brief

There is limited evidence as to the risk of abnormalities on CT or clinically important traumatic brain injury (ciTBI) in children with ventricular shunts (VSs) who sustain mild TBI. The authors sought to determine the frequency of these outcomes in children with VSs in a prospective multicenter study. Of 20,137 children with TBI, 35 (0.2%) had a VS. One patient had a CT abnormality, but none required neurosurgery. The rate of ciTBI in children with and without VSs was similar. Congruent with existing evidence, this study provides reasonable grounds to support a more restrictive approach to imaging than current practice.

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In Brief

Using finite element modeling techniques, the authors investigated craniocervical biomechanics in a pediatric patient with Down syndrome (DS). Two age-matched models with identical material properties, one of a patient with DS and one of a child without DS, were created and tested. The authors found increases in craniocervical motion with the DS model, supporting the hypothesis that bony geometry plays a large part in the excessive craniocervical motion that occurs in DS patients and calling into question the role of ligamentous laxity.

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In Brief

This investigation is aimed at gaining a better understanding of the factors that lead to the mechanical failure of ventriculoperitoneal shunts used for the treatment of hydrocephalus. Our study demonstrates a correlation between shunt mechanical stiffness and shunt disconnection, that catheters that are more flexible are secured for longer periods to their valve counterpart and have a decreased propensity to disconnect. These findings may be utilized to decrease shunt disconnection due to mechanical failure.

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In Brief

Researchers evaluated differences in blood loss between racial groups undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). There is no relationship between race and blood loss during PSF for AIS. Standardized protocols for minimizing perioperative blood loss can be applied to both Caucasian and African American patients.

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In Brief

The authors reported a retrospective case review of 14 patients with basal encephalocele. Surgical strategy for selection of the approach (transoral transpalatal, transfrontobasal, and endoscopic transnasal) depended on the location, presence of cleft palate, and size of the bone defect. A titanium mesh/plate was recommended material for the skull base reconstruction. The paper provides a comprehensive understanding of the basal encephalocele and its surgical management.

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In Brief

This study evaluates an obex exploration technique in pediatric patients with Chiari type-I malformation (CM-I). Patients with a syrinx who underwent expansile duraplasty with obex exploration had a significantly greater likelihood of syrinx and symptom resolution compared with bone-only decompression, without a higher risk of CSF-related complications. Risks and benefits associated with surgical options for treatment of CM-I are ill defined; this study may inform these decisions

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In Brief

This study summarizes the authors’ experience using surgery and other related technology to successfully treat ruptured rolandic arteriovenous malformations with minimal neurological morbidity. This study addresses an important gap in understanding the role of surgery for treating these lesions.

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In Brief

The authors present a novel method of extraoperative stereoelectroencephalography (SEEG) monitoring complemented by subsequent intraoperative recordings, designed to tailor multistaged resections in rolandic and perirolandic cortex in a highly selected group of patients with pharmacoresistant rolandic and perirolandic focal epilepsy. The results testified to the feasibility and demonstrated the value of the combined benefits of both extra- and intraoperative SEEG recordings when resecting the rolandic and perirolandic areas. With the proposed novel hybrid method one can precisely limit the volume of resection necessary to abort epileptic activity while preserving the functional cortex as much as possible.

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In Brief

The authors looked back at all brain tumors of the fourth ventricle treated at their hospital over the past 17 years to see what the burden of complications was in these children, in the largest such study to date. The authors show that complication rates are high in this type of surgery, and particularly that speech problems are common, but this does not appear to be affected by the surgical approach.

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In Brief

Primary brachial plexus nerve reconstruction consists of nerve grafting and nerve transfer. There is continued debate among surgeons regarding which of these two options provides the most optimal outcomes. This study examined outcomes for shoulder function in patients with either nerve grafting or nerve transfer. In this study, there appears to be an advantage in external rotation of the shoulder in patients who underwent nerve transfer repair.

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In Brief

This manuscript analyzes the demographic trends of emergency evaluations for pediatric patients presenting with suspected shunt malfunctions in the United States between 2006 and 2017. Prior studies have not described these overarching trends or related hospital and patient characteristics associated with receiving surgery to correct a malfunction. Understanding the epidemiology, diagnostic workups, and surgical revision rates of this patient population over time is important for further improving diagnostic and treatment efforts for shunt malfunctions.

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In Brief

The authors investigated the 1-year costs of ICU-treated pediatric traumatic brain injury (TBI) in Finland. Increased injury severity was associated with increased total 1-year cost, and the majority of the total 1-year resources were spent on patients with favorable outcomes, suggesting that ICU treatment of pediatric TBI is cost-effective. This study is important because Finland’s public tax-funded healthcare system allows assessment of costs of the entire treatment chain, making Finland one of the few places where reliable health economics studies can be carried out.

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In Brief

The objective of this study is to describe a combined dorsal and ventral rhizotomy for patients with concurrent spasticity and dystonia through a technical note. The key finding, and value added by this paper, is to perform the procedure through a conus-level laminectomy rather than an L1–S1 laminoplasty.

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In Brief

Hydrocephalus is a lifelong disease that gives pediatric neurosurgeons and patient families the opportunity to develop long-lasting relationships. Surgeons often discuss parents’ concerns and economic issues during clinic visits. The authors sought to understand the interaction between socioeconomic status and parental concern. They found that more engaged parents, regardless of their socioeconomic background, reported better overall child health. While poorer parents were more concerned about their child, this did not affect their child’s current health.

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In Brief

The researchers surveyed pediatric neurosurgeons in Asia and Australasia to get an overview of their training and current clinical practice. Both fellowship-trained and general neurosurgeons provided neurosurgical care to children in the region, and respondents expressed a desire to train further in pediatric epilepsy, spasticity, vascular malformations, craniofacial disorders, and brain tumors. These training needs have to be considered when structuring fellowship programs and teaching courses in pediatric neurosurgery.

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In Brief

This systematic review was conducted to compare and evaluate the efficacy and outcome of the nonsurgical management of atlantoaxial rotatory fixation (AARF). The authors found that there is a lack of level I evidence comparing the different nonsurgical management methods in AARF and that the available data come from uncontrolled nonrandomized studies. This highlights the need for well-designed comparative studies to determine the best nonsurgical approach to the management of AARF.

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In Brief

The authors investigated total opioid use and pain control with a single intraoperative dose of liposomal bupivacaine (LB) after Chiari decompression in pediatric patients. Compared with controls, patients administered LB had reduced pain scores and opioid use in the first 24 postoperative hours. During later hospitalization the effect was less evident, but complete nonopioid analgesia was possible in some LB-treated patients. This study is, to the authors’ knowledge, the first to describe LB as a possibly useful analgesic for severe postoperative pain that frequently follows pediatric Chiari surgery.

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In Brief

Intrinsic epidermoid tumors of the brainstem are rare, histologically benign lesions associated with a high surgical morbidity and mortality due to their eloquent location. The authors describe a novel technique of endoscope-assisted microsurgery for managing symptomatic lesions and recommend a strategy of conservative surgery with resection of as much of the tumor capsule as is safely possible.

Restricted access

In Brief

Researchers studied if the external remote used to change magnetic growth rods used in scoliosis treatment also changed the settings of programmable shunt valves. The external programmer that changes the growth rods can change a shunt valve's settings if it is in close contact with the shunt valve. This finding brings awareness to clinicians that in patients with both types of hardware, the settings of the shunt valve should be checked after magnetic rod adjustment.

Restricted access

In Brief

Chiari malformation type I has traditionally been defined by the amount of herniation of the cerebellar tonsils below the skull base. However, symptoms are caused by compression of the brainstem. In this paper, the authors demonstrate that the amount of tissue (cerebellum and brainstem) in the opening at the base of the skull is more predictive of the need for surgery than simply measuring the degree of herniation.

Restricted access

In Brief

Optimizing convection-enhanced delivery (CED) for neurooncological therapeutic strategies will likely demand sequential treatments. This clinical series was intended to report on the use of multiple CED procedures and repeat dosing in children with diffuse intrinsic pontine glioma. These encouraging results related to safety, accuracy, and feasibility provide an impetus for improved clinical trial design and greater enthusiasm for device research and development.

Restricted access

In Brief

The authors evaluated postoperative pediatric neurosurgical patients in order to determine how common postoperative fevers are and how common and helpful workups are in these patients. The authors determined that performing invasive and costly fever workups are not worthwhile in these patients in the first 4 postoperative days.

Restricted access

In Brief

The authors created an MRI spine protocol using fast sequencing to avoid sedation in pediatric patients and then assessed its use in identifying and monitoring syrinx and spinal dysraphism. They report the first pediatric series of a fast-sequence spine MRI protocol for use in young patients that does not require sedation and is able to identify and monitor syrinx and spinal dysraphism.

Restricted access

In Brief

The authors studied the use of subdural grids for invasive monitoring in pediatric patients 3 years old and younger with refractory epilepsy. While overall complication rates were higher in this younger cohort, subdural grid placement was not associated with an increased risk of surgical complications in that population. The study is important because there is a lack of information about the utility of this technique in very young pediatric patients, its risks, and outcomes.

Free access
Open access

In Brief

The main objective of this study was to show the feasibility of fetal occipital encephalocele repair. The study showed that patients who underwent fetal correction of an occipital encephalocele experienced reversal of microcephaly and may have a satisfactory cognitive outcome when compared with patients treated after birth. The study opens new horizons for fetal neurosurgery.

Restricted access

In Brief

The authors’ objective was to verify intracranial injury due to short falls and examine the characteristics of these falls in infants and toddlers. In the objective classification of patients into groups based on whether or not the fall was witnessed by a nonrelative, subdural hematoma, retinal hemorrhage, and neurological sequelae due to short falls were not seen after witnessed falls. This study provided the findings in a novel way to reduce the risk of misclassification and circular reasoning.

Restricted access

In Brief

Hydrocephalus is primarily a disease of childhood in low- and-middle-income countries. Zambia is a nation in sub-Saharan Africa of 17 million people in which over half of the population lives below the international poverty line. To date, information about neurosurgical management of pediatric hydrocephalus in Zambia has been inferred from neighboring countries since no data currently exist. The authors’ research closes that gap. This study describes pediatric hydrocephalus surgical outcomes and predictors of postoperative complications.

Restricted access

In Brief

The authors attempted to evaluate the effectiveness and safety of ventricular irrigation in cases of cerebral ventriculitis in a pediatric population, including using both endoscopic lavage as well as lavage with two-tube irrigation. The results showed a significance advantage of the lavage/irrigation technique over the conventional treatment methods (drainage with an external ventricular drain as well as systemic and intraventricular antibiotics) regarding survival, morbidity, and hospital stay duration. The study shows that ventricular lavage/irrigation is safe and effective in cases of cerebral ventriculitis in the pediatric population and neonates.

Restricted access

In Brief

The objective of this study was to define the inflammatory response within the brain after intraventricular hemorrhage by using a neonatal rat model. After hemoglobin injection into the lateral ventricle, there was an acute inflammatory response, followed by oxidative stress that was concentrated in white matter. This study suggests that anti-inflammatory treatment for intraventricular hemorrhage may need to be given very early after injury in order to be effective.

Restricted access

In Brief

This paper’s objective is to demonstrate a novel innovative approach to tissue-sparing hemispherotomy in patients with intractable hemispheric epilepsy without a lateral ventricle. The surgery successfully disconnected the pathologic hemisphere and the patient has been seizure free with significant improvement in achieving developmental milestones. This technique illustrates a surgical disconnection option with low morbidity for patients who would otherwise undergo a hemispherectomy with a higher risk of significant morbidity and mortality.