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Association Between Behavioral and Learning Outcomes and Single Exposures to Procedures Requiring General Anesthesia
David O Warner1, Danqing Hu1, Michael J Zaccariello2
1From the Departments of Anesthesiology and Perioperative Medicine.
Insights
A single exposure to anesthesia before age 3 did not significantly increase the risk of attention-deficit hyperactivity disorder (ADHD) or learning disabilities (LD). This study found no evidence linking early anesthesia exposure to later developmental or educational challenges.
Area of Science:
- Pediatric Anesthesiology
- Developmental Neuroscience
- Public Health
Background:
- Previous studies indicated multiple anesthesia exposures before age 3 correlate with increased ADHD and learning disabilities.
- This research investigates the impact of single anesthesia exposures on child development.
Purpose of the Study:
- To determine if a single exposure to anesthesia before age 3 increases the risk of attention-deficit hyperactivity disorder (ADHD).
- To examine associations between single anesthesia exposures and learning disabilities (LD) or the need for individualized educational plans.
Main Methods:
- Secondary analysis of two retrospective cohort studies involving children born between 1976-1982 and 1996-2000.
- Compared outcomes in 5339 unexposed children versus 1054 children with single anesthesia exposure before age 3.
- Utilized inverse probability of treatment weighted proportional hazards models to assess ADHD, LD, and individualized education plan incidence.
Main Results:
- The cumulative frequency of ADHD at age 18 was 7.3-13.0% in unexposed children and 8.1-17.6% in singly exposed children across cohorts.
- Weighted analyses showed no significant association between single anesthesia exposures and increased ADHD (HR, 1.21; P=.184).
- No significant association was found for learning disabilities (HR, 0.98) or the need for individualized education plans.
Conclusions:
- This study found no evidence that single exposures to general anesthesia before age 3 are linked to a higher risk of ADHD.
- Results suggest that single early anesthesia exposures do not increase the likelihood of learning disabilities or the need for special educational services.
Background:
Two prior population-based (children born in Olmsted County, MN), retrospective cohort studies both found that multiple exposures to anesthesia before age 3 were associated with a significant increase in the frequency of attention-deficit hyperactivity disorder (ADHD) and learning disabilities (LD) later in life. The primary purpose of this secondary analysis of these data was to test the hypothesis that a single exposure to anesthesia before age 3 was associated with an increased risk of ADHD. We also examined the association of single exposures with LD and the need for individualized educational plans as secondary outcomes.
Methods:
This analysis includes 5339 children who were unexposed to general anesthesia before age 3 (4876 born from 1976 to 1982 and 463 born from 1996 to 2000), and 1054 children who had a single exposure to anesthesia before age 3 (481 born from 1976 to 1982 and 573 born from 1996 to 2000). The primary outcome of interest was ADHD. Secondary outcomes included LD (reading, mathematics, and written language) and the need for individualized educational programs (speech/language and emotion/behavior). To compare the incidence of each outcome between those who were unexposed and singly exposed to anesthesia before the age of 3 years, an inverse probability of treatment weighted proportional hazards model was used.
Results:
For children not exposed to anesthesia, the estimated cumulative frequency (95% confidence interval [CI]) of ADHD at age 18 was 7.3% (95% CI, 6.5-8.1) and 13.0% (95% CI, 10.1-16.8) for the 1976-1982 and 1996-2000 cohorts, respectively. For children exposed to a single anesthetic before age 3, the cumulative frequency of ADHD was 8.1% (95% CI, 5.3-12.4) and 17.6% (95% CI, 14.0-21.9) for the 1976-1982 and 1996-2000 cohorts, respectively. In weighted analyses, single exposures were not significantly associated with an increased frequency of ADHD (hazard ratio [HR], 1.21; 95% CI, 0.91-1.60; P = .184). Single exposures were also not associated with an increased frequency of any LD (HR, 0.98; 95% CI, 0.78-1.23), or the need for individualized education plans.
Conclusions:
This analysis did not find evidence that single exposures to procedures requiring general anesthesia, before age 3, are associated with an increased risk of developing ADHD, LD, or the need for individualized educational plans in later life.
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