The impact of general anesthesia on child development and school performance: a population-based study
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Published on: September 19, 2019
Francisco J Schneuer1, Jason P Bentley1, Andrew J Davidson2
1Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia.
Insights
Children exposed to general anesthesia before age four show poorer school readiness and academic performance, particularly in numeracy. Further research is needed to understand these long-term neurodevelopmental effects.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Pediatrics
- Public Health
Background:
- Growing concern exists regarding potential adverse neurocognitive effects of early childhood exposure to general anesthesia and surgery.
- Understanding these effects is crucial for pediatric patient safety and long-term outcomes.
Purpose of the Study:
- To investigate the association between early childhood exposure to general anesthesia and subsequent developmental and school performance.
- To identify specific risks related to developmental assessments and academic achievement.
Main Methods:
- A data linkage study in New South Wales, Australia, included children born without major congenital anomalies or neurodevelopmental disabilities.
- Compared children exposed to general anesthesia before 48 months with those without hospitalization, analyzing developmental assessments and Grade 3 school test results.
- Outcomes included developmental risk classification and performance in national numeracy and reading tests.
Main Results:
- Children exposed to general anesthesia showed increased odds of being developmentally high risk (17%), and scoring below national standards in numeracy (34%) and reading (23%).
- The association between general anesthesia exposure and developmental risk or poor reading attenuated for children with a single hospitalization.
- However, the link between early general anesthesia exposure and poor numeracy outcomes persisted even with a single hospitalization.
Conclusions:
- Early exposure to general anesthesia (before age 4) is associated with poorer school entry development and academic performance.
- While risks for developmental delay and reading difficulties were reduced with single exposure, poor numeracy outcomes remained a concern.
- Further research is essential to elucidate the specific impacts of general anesthesia, considering factors like procedure duration and underlying health conditions.
Background:
There has been considerable interest in the possible adverse neurocognitive effects of exposure to general anesthesia and surgery in early childhood.
Aims:
The aim of this data linkage study was to investigate developmental and school performance outcomes of children undergoing procedures requiring general anesthesia in early childhood.
Methods:
We included children born in New South Wales, Australia of 37+ weeks' gestation without major congenital anomalies or neurodevelopmental disability with either a school entry developmental assessment in 2009, 2012, or Grade-3 school test results in 2008-2014. We compared children exposed to general anesthesia aged <48 months to those without any hospitalization. Children with only 1 hospitalization with general anesthesia and no other hospitalization were assessed separately. Outcomes included being classified developmentally high risk at school entry and scoring below national minimum standard in school numeracy and reading tests.
Results:
Of 211 978 children included, 82 156 had developmental assessment and 153 025 had school test results, with 12 848 (15.7%) and 25 032 (16.4%) exposed to general anesthesia, respectively. Children exposed to general anesthesia had 17%, 34%, and 23% increased odds of being developmentally high risk (adjusted odds ratio [aOR]: 1.17; 95% CI: 1.07-1.29); or scoring below the national minimum standard in numeracy (aOR: 1.34; 95% CI: 1.21-1.48) and reading (aOR: 1.23; 95% CI: 1.12-1.36), respectively. Although the risk for being developmentally high risk and poor reading attenuated for children with only 1 hospitalization and exposure to general anesthesia, the association with poor numeracy results remained.
Conclusion:
Children exposed to general anesthesia before 4 years have poorer development at school entry and school performance. While the association among children with 1 hospitalization with 1 general anesthesia and no other hospitalization was attenuated, poor numeracy outcome remained. Further investigation of the specific effects of general anesthesia and the impact of the underlying health conditions that prompt the need for surgery or diagnostic procedures is required, particularly among children exposed to long duration of general anesthesia or with repeated hospitalizations.
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