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Early life anesthesia does not pose significant long-term risk for children
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Children exposed to anesthesia for surgery prior to age 4 years had a slightly greater risk for lower academic performance and intelligence quotient scores in adolescence than children who had not been exposed to anesthesia until age 16 years, according to recent findings from Sweden.
“While retrospective investigations have failed to identify an association with later academic performance after one exposure to anesthesia and surgery, multiple exposures are consistently associated with an increased risk for learning or cognitive disabilities,” Pia Glatz, MD, of the Karolinska Institutet, and colleagues wrote. “Reasons for these divergent results have been proposed, including confounding by indication and the effect of comorbidities driven by the underlying disorder.
“Nevertheless, a major challenge has been to obtain a large enough sample size to provide adequate statistical power and a sensitive and uniformly applied outcome measure of neurocognitive development or academic performance to detect long-term neurocognitive outcomes or impaired academic outcomes among children exposed to surgery in early life.”
To determine the relationship between exposure to anesthesia before age 4 years with academic and cognitive performance later in life, the researchers conducted a cohort study among all children born in Sweden between 1973 and 1993. School grades at age 16 years and IQ test scores at military conscription age 18 were analyzed between April 2013 and October 2015. The main cohort included 33,154 children who underwent one surgery and anesthesia exposure prior to age 4 years with no later surgery or hospitalization and 159,619 children who had not had surgery or been exposed to anesthesia before age 16 years.
Researchers also studied 3,640 children who underwent several surgeries and anesthesia exposures prior to age 4 years.
A model that included sex, birth month in the same year, gestational age at delivery, annual taxable household income, Apgar score at 5 minutes, parental educational levels and cohabitation and number of siblings estimated the mean difference between the exposed and unexposed cohorts. Analysis showed an average difference of 0.41% (95% CI, 0.12-0.7) lower school grades for one exposure to anesthesia prior to age 4 years. The researchers observed 0.79% (95% CI, 0.25-1.33) lower grades in children exposed between ages 37 and 48 months. They did not detect significant differences in school grades with one exposure at ages 6 months, 7 to 12 months, 13 to 24 months or between 25 to 36 months.
They retrieved IQ tests from the military conscription review, which contained results from 9,198 exposed boys and 45,115 unexposed boys. Average IQ test scores among boys with one exposure to anesthesia prior to age 4 years were 0.97% (95% CI, 0.15-1.78) lower than IQ scores from unexposed boys.
“While more vulnerable subgroups of children may exist, the low overall difference in academic performance after childhood exposure to surgery is reassuring,” the researchers said in a press release. “These findings should be interpreted in light of potential adverse effects of postponing surgery.” – by Kate Sherrer
Disclosure: Glatz reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.
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