Early childhood general anesthesia and risk of Attention Deficit Hyperactivity Disorder

Abstract

BackgroundThe relationship between early childhood exposure to general anesthesia (GA) and the risk of developing Attention Deficit Hyperactivity Disorder (ADHD) is still uncertain and previous studies have presented conflicting results. This population‐based cohort study aimed to investigate the potential relationship between GA exposure and ADHD risk using propensity score matching (PSM) in a large sample size.MethodsThe study included 15,072 children aged 0–3 years who received GA and were hospitalized for more than 1 day in Taiwan from 2004 to 2014. The nonexposed group was randomly selected through 1:1 PSM from the Taiwan Maternal and Child Health Database (TMCHD). The primary objectives of this study were to determine the incidence rates (IR) and incidence rate ratios (IRR) of ADHD in the two cohorts, employing Poisson regression models.ResultsThe GA group and non‐GA group each comprised 7,536 patients. The IR of ADHD was higher in the GA group (122.45 per 10,000 person‐years) than in the non‐GA group (64.15 per 10,000 person‐years), and the IRR of ADHD in the GA group was 1.39 (95% CI: 1.26, 1.55). The study found that the number of times of exposure to GA, duration of exposure, male gender, and central nervous system surgery were significant risk factors for ADHD in the future.ConclusionsThis study's findings suggest that there is a significant correlation between early childhood exposure to GA and the risk of developing ADHD, and GA may be an important risk factor for ADHD in children undergoing surgery. The study also identified several risk factors for ADHD, including the number of times of exposure to GA, duration of exposure, male gender, and central nervous system surgery.

Associations between the Duration of General Anesthesia Exposure and Attention Deficit Hyperactivity Disorder (ADHD) as well as Behavioral Problems

“…Attentional de cits and hyperactivity disorders tend to be more prevalent in male than in female children [42], whereas female sex is an established risk factor for anxiety disorders [43]. A clinical study has also shown that male sex is signi cantly associated with ADHD [7]. These ndings are consistent with our study ndings in the subgroup analyses of sex.…”

“…The ndings of our study also suggested that prolonged anesthesia (≥ 3 hours) was associated with an increased risk of ADHD. In another study, the aHRs of ADHD in children who underwent general anesthesia for less than 3 hours or 3 hours or more were 1.20 (95% CI: 1.07, 1.99) and 1.89 (95% CI: 1.48, 2.16), respectively, compared to those who did not receive general anesthesia [7]. In our study, we also found that the dimension of impulsivity-hyperactivity differed signi cantly between prolonged-exposure children and unexposed children, but there was no statistically signi cant difference between children exposed for less than 3 hours and unexposed children.…”

“…Previous studies revealed an association between ADHD and general anesthesia exposure [7,18,22,23,25], but several studies have shown no increased risk of ADHD [17,21]. ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity and can have signi cant impacts on academic and occupational performance [26,27].…”

“…The Food and Drug Administration (FDA) has also warned that children under 3 years old exposed to multiple or prolonged general anesthesia may experience neurodevelopmental impacts [6]. Synaptogenesis is a crucial process in brain development that occurs predominantly during the third trimester of pregnancy and peaks at approximately 3 years of age [1,7]. Animal studies have shown that exposure to anesthetics during this critical period can lead to neurodevelopmental impacts [8].…”

“…However, other studies have not shown a signi cant association between general anesthesia and the occurrence of ADHD or other adverse neurodevelopmental outcomes [17,21]. Most related studies have focused on exploring the relationship between the number of general anesthesia exposures and the development of ADHD as well as other neurodevelopmental outcomes [18,22,23], with limited research on the association between the duration of general anesthesia exposure and the risk of ADHD [7].…”