Association between surgical procedures under general anesthesia in infancy and developmental outcomes at 1 year: the Japan Environment and Children’s Study

Abstract

Background: The neurotoxicity of general anesthesia to the developing human brains is controversial. We assessed the associations between surgery under general anesthesia in infancy and development at age 1 year using the Japan Environment and Children's Study (JECS), a large-scale birth cohort study. Methods: In the JECS, 103,062 pregnancies and 104,065 fetuses were enrolled between January 2011 and March 2014. Of the 100,144 registered live births, we excluded preterm or post-term infants, multiple births, and infants with chromosomal anomalies and/or anomalies of the head or brain. Data on surgical procedures under general anesthesia in infancy were collected from self-administered questionnaires by parents at the 1-year follow-up. Developmental delay at age 1 year was assessed using the Japanese translation of the Ages and Stages Questionnaires, Third Edition (J-ASQ-3), comprising five developmental domains. Results: Among the 64,141 infants included, 746 infants had surgery under general anesthesia once, 90 twice, and 71 three or more times. The percentage of developmental delay in the five domains of the J-ASQ-3 significantly increased with the number of surgical procedures. After adjusting for potential confounding factors, the risk of developmental delays in all five domains was significantly increased in infants who had surgery under general anesthesia three times or more (adjusted odds ratios: for communication domain 3.32; gross motor domain 4.69; fine motor domain 2.99; problem solving domain 2.47; personal-social domain 2.55). Conclusions: Surgery under general anesthesia in infancy was associated with an increased likelihood of developmental delay in all five domains of the J-ASQ-3, especially the gross motor domain at age 1 year. The neurodevelopment with the growth should be further evaluated among the children who had surgery under general anesthesia.

A National Population Cohort Study Showed That Exposure to General Anesthesia in Early Childhood Is Associated with an Increase in the Risk of Developmental Delay

“…Our results also showed no significant association with the later development of ADHD, autism spectrum disorder or intellectual disabilities and GA exposure in early life of children. Consistent with the findings of Feng and Kobayashi et al, previous retrospective observational studies also found that children exposed to GA would have an increased risk of DD [29,30]. Compared with healthy siblings who were not exposed to anesthesia, there was no statistical difference in intelligence quotient scores in later childhood [31].…”

Office Insertion of Tympanostomy Tubes and the Role of Automated Insertion Devices

“…10 Other reviewers acknowledge the potential for general anesthesia to induce neurotoxicity but note scant evidence to support a significant clinical effect. 11,12 Recent findings from large-cohort and population-based studies have been conflicting, with some showing developmental delays after anesthetic exposure prior to age 2 years 13,14 and others concluding no impact of a single exposure before age 3 to 4 years on adverse behavior or learning outcomes in later life. 15,16…”

Neuroplacentology in congenital heart disease: placental connections to neurodevelopmental outcomes

“… 48 This may be confounded by the fact that many with CHD undergo multiple surgeries in childhood, as the number of surgical procedures has been associated with progressively deleterious impact on neurodevelopment in a large birth cohort study in Japan. 49 Together, these data suggest that the etiology of neurodevelopmental outcomes in children with CHD are complex, and multifactorial, depending upon factors both within and outside the surgical and postoperative periods.…”