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Risk of attention deficit hyperactivity disorder diagnosis following multiple exposures to general anesthesia in the
Megan Skakum1, Audrey Katako1, Jenna Mitchell-Dueck2
1University of Manitoba Master of Physician Assistant Studies Program, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Multiple exposures to general anesthesia before age 5 are linked to a higher risk of attention deficit hyperactivity disorder (ADHD) diagnosis. This systematic review found a significant association in children.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Disorders
Background:
- The potential link between early-life anesthesia exposure and neurodevelopmental outcomes like ADHD is a subject of ongoing research and debate.
- Understanding this association is crucial for pediatric patient safety and long-term health.
Purpose of the Study:
- To systematically review and synthesize existing literature on the association between multiple general anesthesia exposures before age 5 and subsequent ADHD diagnosis.
- To quantify the risk of ADHD following early-life multiple anesthetic exposures.
Main Methods:
- A comprehensive systematic search was conducted across EMBASE, PubMed, and SCOPUS databases for studies published after 1980.
- Inclusion criteria focused on otherwise healthy children with at least two general anesthesia exposures before age 5, diagnosed with ADHD before age 19.
- Meta-analysis was employed for studies reporting hazard ratios (HR) and 95% confidence intervals (CI), with GRADE and PRISMA guidelines followed.
Main Results:
- Eight studies involving 196,749 children were included in the review.
- Meta-analysis of five studies revealed a significant association between multiple anesthesia exposures and ADHD diagnosis (HR: 1.71; 95% CI: 1.59, 1.84).
- The remaining three studies not included in the meta-analysis also indicated an increased risk of ADHD.
Conclusions:
- A clear association exists between multiple early-life general anesthesia exposures and the later diagnosis of attention deficit hyperactivity disorder.
- These findings highlight a potential neurodevelopmental risk associated with repeated early anesthetic exposures.
Objectives:
The risk of attention deficit hyperactivity disorder (ADHD) following multiple exposures to anesthesia has been debated. Our objective was to systematically review the literature to examine the association between multiple exposures to general anesthesia before age 5 and subsequent diagnosis of ADHD.
Methods:
A systematic search of EMBASE, PubMed, and SCOPUS was performed using key search terms in February 2022. We included studies that: were published after 1980, included only otherwise healthy children who experienced two or more exposures to general anesthetic before age 5, diagnosed ADHD by a medical professional before age 19 years after exposure to general anesthetic, were cross-sectional, case-control, or cohort study, and were published in English. The results (expressed as hazard ratios [HR] and associated 95% confidence intervals [CI]) were pooled using meta-analytic techniques. Studies which did not present their results as HR and 95% CI were analyzed separately. GRADE was used to determine the certainty of the findings. PRISMA guidelines were followed at each stage of the review.
Results:
Eight studies (196,749 children) were included. Five reported HR and 95% CI and were subsequently pooled for meta-analysis. Multiple exposures to anesthesia were associated with diagnosis of ADHD before the 19th year of life (HR: 1.71; 95% CI: 1.59, 1.84). Two of the three studies not used in the meta-analysis also found an increased risk of ADHD diagnosis following multiple anesthetic exposures.
Conclusions:
There was an association between multiple early exposures to general anesthesia and later diagnosis of ADHD.
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