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The effects of exposure to general anesthesia in infancy on academic performance at age 12
Choon Looi Bong1, John Carson Allen, Josephine Tan Swee Kim
1From the *Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Yong Loo Lin School of Medicine; and †Centre for Qualitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
Insights
Infants exposed to general anesthesia for surgery may have a higher risk of learning disabilities later in life. This study found a 4.5 times greater odds of diagnosis in children who underwent anesthesia before age one.
Area of Science:
- Pediatric Anesthesiology
- Developmental Neuroscience
- Educational Psychology
Background:
- Animal models suggest anesthetic exposure during development can cause brain damage and learning deficits.
- The impact of early-life general anesthesia on human neurodevelopment and academic outcomes remains unclear.
- This study investigates potential links between infant anesthesia and later academic achievement.
Purpose of the Study:
- To determine if children exposed to general anesthesia in infancy exhibit differences in academic achievement at age 12.
- To compare Singapore's Primary School Leaving Examination (PSLE) scores between exposed and unexposed children.
- To assess the rate of formally diagnosed learning disabilities in both groups.
Main Methods:
- A pilot observational cohort study comparing 100 children exposed to general anesthesia before age 1 with 106 age-matched controls.
- Data collected via telephone interviews with parents regarding medical, school, and home environments.
- Children were assessed at age 12 for PSLE scores and learning disability diagnoses.
Main Results:
- No statistically significant difference in mean PSLE aggregate scores between the anesthesia-exposed and control groups.
- A significantly higher rate of formally diagnosed learning disabilities in the anesthesia-exposed group (15%) compared to controls (3.77%).
- The odds of a learning disability diagnosis were 4.5 times greater for children exposed to general anesthesia.
Conclusions:
- Early-life exposure to general anesthesia for minor surgery is associated with a 4.5-fold increased odds of formal learning disability diagnosis by age 12.
- The study's precision was insufficient to rule out clinically relevant differences in PSLE scores.
- Further research is needed to confirm these findings and understand the underlying mechanisms.
Background:
Recent evidence from juvenile animal models has shown that exposure to anesthetic drugs above threshold doses during a critical neurodevelopmental window causes widespread neuronal apoptosis, resulting in irreversible brain damage and subsequent learning difficulties. The relevance of this to human infants having general anesthesia for minor surgery is unknown. In this pilot observational cohort study, we sought to determine whether children exposed to general anesthesia for minor surgery during infancy exhibited differences in academic achievement at age 12 years, as evidenced by (1) lower aggregate scores in the Singapore standardized Primary School Leaving Examination (PSLE) and (2) formally diagnosed learning disability, compared with children who were never exposed to anesthesia or sedation.
Methods:
We compared 100 full-term, apparently healthy children aged 12 years who were exposed to general anesthesia for minor surgery before age 1 at our institution with an age-matched cohort of 106 children who were never exposed to anesthesia or sedation. Parents of children completed a 20-minute telephone interview with questions regarding their children's medical history, school environment, and home environment.
Results:
The difference in mean PSLE aggregate scores (3.0; 95% confidence interval [CI], -8.3 to 14.3) between exposed (197.0; 95% CI, 185.6-208.4) and control groups (194.0; 95% CI, 182.9-205.1) was not statistically significant (P = 0.603). The presence of formally diagnosed learning disability was 15% (15 of 100) in the exposed group compared with 3.77% (4 of 106) in the control group (P < 0.001). The odds ratio for a formal diagnosis of learning disability in those exposed to general anesthesia relative to controls was 4.5 (95% CI, 1.44-14.1).
Conclusion:
The odds of a formal diagnosis of learning disability by age 12 years in apparently healthy children exposed to general anesthesia for minor surgery during infancy were 4.5 times greater than their peers who had never been exposed to anesthesia. However, study precision was inadequate to detect a clinically relevant difference in PSLE scores.
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