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Published on: August 25, 2014
Association between surgical procedures under general anesthesia in infancy and developmental outcomes at 1 year: the
Yoshiko Kobayashi1,2, Narumi Tokuda1, Sho Adachi1,3
1Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan.
Insights
Infants undergoing multiple surgeries with general anesthesia showed increased developmental delays by age 1. Further evaluation of neurodevelopment is needed for these children.
Area of Science:
- Pediatric Anesthesiology
- Developmental Pediatrics
- Neuroscience
Background:
- The neurotoxicity of general anesthesia in developing brains is a significant concern.
- The Japan Environment and Children's Study (JECS) is a large-scale birth cohort study investigating environmental factors and child development.
- The association between early-life surgery under general anesthesia and subsequent neurodevelopment requires clarification.
Purpose of the Study:
- To assess the association between surgery under general anesthesia in infancy and developmental outcomes at age 1 year.
- To determine if the number of surgical procedures correlates with developmental delay.
- To identify specific developmental domains affected by early-life general anesthesia exposure.
Main Methods:
- Utilized data from the Japan Environment and Children's Study (JECS), enrolling over 100,000 pregnancies.
- Included 64,141 infants, excluding those with preterm birth, multiple births, or congenital anomalies.
- Assessed developmental delay at age 1 year using the Japanese version of the Ages and Stages Questionnaires, Third Edition (J-ASQ-3).
Main Results:
- Among 64,141 infants, 746 had one surgery, 90 had two, and 71 had three or more procedures under general anesthesia.
- Developmental delay in all five J-ASQ-3 domains increased significantly with the number of surgeries.
- Infants with three or more surgeries showed significantly higher adjusted odds ratios for developmental delays across all domains.
Conclusions:
- Surgery under general anesthesia in infancy is linked to a higher risk of developmental delay at age 1 year.
- The gross motor domain was particularly affected, alongside communication, fine motor, problem-solving, and personal-social domains.
- Long-term neurodevelopmental outcomes in children exposed to early-life general anesthesia warrant further investigation.
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.
Trial Registration:
UMIN Clinical Trials Registry (number: UMIN000030786 ).
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