Neurodevelopmental outcomes in infants undergoing general anesthesia

Nestor, Kelsey; Zeidan, Michelle; Boncore, Erin; Richardson, Aaron; Alex, Gijo; Weiss, Michael D.; Islam, Saleem

doi:10.1016/j.jpedsurg.2017.03.008

Cited by 24 publications

(32 citation statements)

References 21 publications

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“…Infants diagnosed with BA are potentially more vulnerable given the absence of alternate treatments and the need for timely surgical intervention (HPE) requiring prolonged general anesthesia (GA) within the first months of life. However, a recent study examining 336 infants found few significant effects of GA in the first year of life on ND outcomes compared with controls 19 . Additionally, interim results from two long-term studies – one a randomized trial comparing GA with regional anesthesia 20 , and another looking at sibling pairs 21 – noted no significant effect of GA on ND outcomes using standardized testing after a single GA exposure.…”

Section: Discussionmentioning

confidence: 95%

Neurodevelopmental Outcome of Young Children with Biliary Atresia and Native Liver: Results from the ChiLDReN Study

Sorensen

Alonso

et al. 2018

The Journal of Pediatrics

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Section: Discussionmentioning

confidence: 95%

Neurodevelopmental Outcome of Young Children with Biliary Atresia and Native Liver: Results from the ChiLDReN Study

Sorensen

Alonso

et al. 2018

The Journal of Pediatrics

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“…Various retrospective studies have also investigated the association between general anesthesia in childhood and adverse neurodevelopmental outcomes. While some have concluded that there is no association [23][24][25][26][27][28][29][30][31], others have suggested otherwise [21,[32][33][34][35][36][37][38][39][40][41][42]. Among the studies reporting that anesthesia does not affect development, many have either set the timing of developmental evaluation at adolescence [23][24][25][26], early after surgery [27,28], or have considered the period before the age of 3-6 years as the time of exposure to anesthesia [23,24,[27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

“…In studies of anesthesia and development, a variety of exposure periods and outcomes has been reported, including neuropsychological assessment [ 21 , 32 – 35 ], degree of learning disability [ 36 – 39 ], and academic performance [ 40 , 41 ]. Some described the effects of anesthesia exposure in infancy [ 21 , 34 , 40 , 42 ], while some had multiple anesthesia exposures [ 38 , 39 ]. Wilder et al [ 39 ] reported that a single exposure to anesthesia by age 4 years was not associated with an increased risk of learning disability, but those with greater exposure were at an increased risk of a learning disability (hazard ratios = 1.59 for two anesthetics and 2.60 for three or more anesthetics).…”

Section: Discussionmentioning

confidence: 99%

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

Kobayashi

Tokuda

Adachi

et al. 2020

Environ Health Prev Med

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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.

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“…A pragmatic non-randomized study might compare (a) GA without surgery e.g. undergoing imaging, endoscopic or interventional procedures, (b) GA with surgery and (c) no GA or surgery23. Careful choice of the category (a) children would be required.…”

Section: Delineating the Neurotoxic Effect Of Anesthesiamentioning

confidence: 99%

Assessing Long-term Neurodevelopmental Outcome Following General Anesthesia in Early Childhood: Challenges and Opportunities

Walkden

Pickering

Gill

2019

Anesthesia &Amp; Analgesia

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Neurodegeneration has been reported in young animals after exposure to all the commonly used general anesthetics (GA). The brain may be particularly vulnerable to anesthetic toxicity during peak synaptogenesis (in gestation and infancy). Human studies of long-term neurodevelopmental outcome following GA in early childhood report contradictory findings. This review assesses the strengths and deficiencies in human research methodologies to inform future studies. We identified 76 studies, published between 1990 and 2017, of long-term neurodevelopmental outcome following early childhood or in utero GA exposure: 49 retrospective, 9 ambi-directional, 17 prospective cohort studies and one randomized controlled trial (RCT). Forty-nine studies were explicitly concerned with anesthetic-induced neurotoxicity (AIN). Full texts were appraised for methodological challenges and possible solutions. Major challenges identified included: delineating effects of anesthesia from surgery; defining the timing and duration of exposure; selection of a surgical cohort and intervention; addressing multiple confounding life course factors; detecting modest neurotoxic effects with small sample sizes (median 131 children, IQR: 50-372); selection of sensitive neurodevelopmental outcomes at appropriate ages for different developmental domains; insufficient length of follow-up (median age: 6 years, IQR: 2-12) and sample attrition. We discuss potential solutions to these challenges. Further adequately powered, multi-center, prospective RCT of AIN in children are required. However, we believe that the inherent methodological challenges of studying AIN necessitate the parallel use of well-designed observational cohort studies.

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Neurodevelopmental outcomes in infants undergoing general anesthesia

Cited by 24 publications

References 21 publications

Neurodevelopmental Outcome of Young Children with Biliary Atresia and Native Liver: Results from the ChiLDReN Study

Neurodevelopmental Outcome of Young Children with Biliary Atresia and Native Liver: Results from the ChiLDReN Study

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

Assessing Long-term Neurodevelopmental Outcome Following General Anesthesia in Early Childhood: Challenges and Opportunities

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