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Attention-deficit/hyperactivity disorder after early exposure to procedures requiring general anesthesia
Juraj Sprung1, Randall P Flick, Slavica K Katusic
1Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. sprung.juraj@mayo.edu
Insights
Repeated exposure to general anesthesia before age 2 increases attention-deficit/hyperactivity disorder (ADHD) risk. Even after accounting for other health issues, multiple anesthesia exposures are linked to higher ADHD rates in children.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Disorders
- Public Health
Background:
- General anesthesia is common in young children for medical procedures.
- Potential long-term neurodevelopmental effects of early-life anesthesia exposure are a concern.
- Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder.
Purpose of the Study:
- To investigate the association between early-life exposure to general anesthesia and the subsequent development of ADHD.
- To determine if the number of exposures influences ADHD risk.
Main Methods:
- A retrospective cohort study of children born between 1976-1982 in Rochester, MN.
- Utilized stringent research criteria to identify ADHD cases diagnosed before age 19.
- Employed Cox proportional hazards regression to analyze the risk of ADHD based on exposure to general anesthesia (none, single, multiple).
- Propensity score matching was used to control for comorbid health conditions.
Main Results:
- Out of 5357 children, 341 ADHD cases were identified (7.6% cumulative incidence).
- Children with two or more exposures to general anesthesia before age 2 had a significantly increased risk of ADHD (HR, 1.95; 95% CI, 1.03-3.71) after adjustment.
- Single exposure to general anesthesia was not significantly associated with an increased ADHD risk (HR, 1.18; 95% CI, 0.79-1.77).
Conclusions:
- Repeated exposure to general anesthesia in early childhood (before age 2) is associated with an elevated risk of developing ADHD.
- This association persists even after accounting for confounding factors like comorbidities.
- Further research may be warranted to understand the mechanisms underlying this link.
Objective:
To study the association between exposure to procedures performed under general anesthesia before age 2 years and development of attention-deficit/hyperactivity disorder (ADHD).
Patients And Methods:
Study patients included all children born between January 1, 1976, and December 31, 1982, in Rochester, MN, who remained in Rochester after age 5. Cases of ADHD diagnosed before age 19 years were identified by applying stringent research criteria. Cox proportional hazards regression assessed exposure to procedures requiring general anesthesia (none, 1, 2 or more) as a predictor of ADHD using a stratified analysis with strata based on a propensity score including comorbid health conditions.
Results:
Among the 5357 children analyzed, 341 ADHD cases were identified (estimated cumulative incidence, 7.6%; 95% confidence interval [CI], 6.8%-8.4%). For children with no postnatal exposure to procedures requiring anesthesia before the age of 2 years, the cumulative incidence of ADHD at age 19 years was 7.3% (95% CI, 6.5%-8.1%). For single and 2 or more exposures, the estimates were 10.7% ( 95% CI, 6.8%-14.4%) and 17.9% ( 95% CI, 7.2%-27.4%), respectively. After adjusting for gestational age, sex, birth weight, and comorbid health conditions, exposure to multiple (hazard ratio, 1.95; 95% CI, 1.03-3.71), but not single (hazard ratio,1.18; 95% CI, 0.79-1.77), procedures requiring general anesthesia was associated with an increased risk for ADHD.
Conclusion:
Children repeatedly exposed to procedures requiring general anesthesia before age 2 years are at increased risk for the later development of ADHD even after adjusting for comorbidities.
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