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Association Between Receipt of General Anesthesia During Childhood and Attention Deficit Hyperactive Disorder and
Joo Young Song1, Hye Ryeong Cha2, Seung Won Lee3
1Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
Insights
General anesthesia with endotracheal intubation (ETI) in children is linked to a higher risk of attention deficit hyperactivity disorder (ADHD). This procedure also correlated with poorer neurodevelopmental screening test outcomes in a large Korean cohort study.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Pediatrics
- Public Health
Background:
- Inconsistent reports exist on the link between general anesthesia and adverse neurodevelopmental/behavioral outcomes in children.
- Understanding this association is crucial for pediatric patient safety and long-term health.
Purpose of the Study:
- To investigate the association between general anesthesia with endotracheal intubation (ETI) and the risk of attention deficit hyperactivity disorder (ADHD) in children.
- To assess the impact of ETI on neurodevelopmental outcomes using a standardized screening tool.
Main Methods:
- Nationwide administrative cohort study of children born in Korea (2008-2009), followed until 2017.
- 93,717 children exposed to general anesthesia with ETI matched 1:1 to unexposed subjects.
- ADHD diagnosis (ICD code F90.X) after 72 months; neurodevelopment assessed via Korean-Ages and Stages Questionnaire (K-ASQ).
Main Results:
- The ETI-exposed group showed a significantly increased risk of ADHD (adjusted hazard ratio, 1.41).
- Higher incidence rate of ADHD in the exposed group (42.6 vs. 27.7 per 10,000 person-years).
- Longer duration and more frequent ETI procedures were associated with greater ADHD risk and poorer K-ASQ results.
Conclusions:
- General anesthesia with ETI in children is associated with an increased risk of ADHD.
- ETI exposure also correlated with suboptimal neurodevelopmental screening test performance.
Background:
There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children.
Methods:
This nationwide administrative cohort study included children born in Korea between 2008 and 2009, and followed until December 31, 2017. The cohort included 93,717 participants who received general anesthesia with endotracheal intubation (ETI) who were matched to unexposed subjects in a 1:1 ratio. General anesthesia was defined by National Health Insurance Service treatment codes with intratracheal anesthesia, and the index date was the first event of general anesthesia. The primary outcome was attention deficit hyperactive disorder (ADHD), which was defined as at least a principal diagnosis of 10th revision of the International Classification of Diseases code F90.X after the age of 72 months. Neurodevelopment, which was assessed using a developmental screening test (Korean-Ages and Stages Questionnaire [K-ASQ]), was a secondary outcome. The K-ASQ is performed annually from 1 to 6 years of age and consists of 5 domains. The association between general anesthesia and ADHD was estimated using a Cox hazard model, and its association with neurodevelopment was estimated using a generalized estimation equation, with control for multiple risk factors beyond 1 year after the index date.
Results:
The median age at the index date was 3.8 (95% confidence interval [CI], 1.7-5.8) years, and there were 57,625 (61.5%) men. During a mean follow-up period of 5 years, the incidence rate of ADHD was 42.6 and 27.7 per 10,000 person-years (PY) in the exposed and unexposed groups, respectively (absolute rate difference 14.9 [95% CI, 12.5-17.3] per 10,000 PY). Compared to the unexposed group, the exposed group had an increased risk of ADHD (adjusted hazard ratio, 1.41 [95% CI, 1.30-1.52]). In addition, a longer duration of anesthesia with ETI and more general anesthesia procedures with ETI were associated with greater risk of ADHD. General anesthesia with ETI was also associated with poorer results in the K-ASQ.
Conclusion:
Administration of general anesthesia with ETI to children is associated with an increased risk of ADHD and poor results in a neurodevelopmental screening test.
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