Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood

Lena S Sun; Guohua Li; Tonya L K Miller; Cynthia Salorio; Mary W Byrne; David C Bellinger; Caleb Ing; Raymond Park; Jerilynn Radcliffe; Stephen R Hays; Charles J DiMaggio; Timothy J Cooper; Virginia Rauh; Lynne G Maxwell; Ahrim Youn; Francis X McGowan

doi:10.1001/jama.2016.6967

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Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood

Journal article

Open access

Peer reviewed

Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood

Lena S Sun, Guohua Li, Tonya L K Miller, Cynthia Salorio, Mary W Byrne, David C Bellinger, Caleb Ing, Raymond Park, Jerilynn Radcliffe, Stephen R Hays, …

JAMA : the journal of the American Medical Association, Vol.315(21), pp.2312-2320

06/07/2016

DOI: 10.1001/jama.2016.6967

PMCID: PMC5316422

PMID: 27272582

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Abstract

Exposure of young animals to commonly used anesthetics causes neurotoxicity including impaired neurocognitive function and abnormal behavior. The potential neurocognitive and behavioral effects of anesthesia exposure in young children are thus important to understand. To examine if a single anesthesia exposure in otherwise healthy young children was associated with impaired neurocognitive development and abnormal behavior in later childhood. Sibling-matched cohort study conducted between May 2009 and April 2015 at 4 university-based US pediatric tertiary care hospitals. The study cohort included sibling pairs within 36 months in age and currently 8 to 15 years old. The exposed siblings were healthy at surgery/anesthesia. Neurocognitive and behavior outcomes were prospectively assessed with retrospectively documented anesthesia exposure data. A single exposure to general anesthesia during inguinal hernia surgery in the exposed sibling and no anesthesia exposure in the unexposed sibling, before age 36 months. The primary outcome was global cognitive function (IQ). Secondary outcomes included domain-specific neurocognitive functions and behavior. A detailed neuropsychological battery assessed IQ and domain-specific neurocognitive functions. Parents completed validated, standardized reports of behavior. Among the 105 sibling pairs, the exposed siblings (mean age, 17.3 months at surgery/anesthesia; 9.5% female) and the unexposed siblings (44% female) had IQ testing at mean ages of 10.6 and 10.9 years, respectively. All exposed children received inhaled anesthetic agents, and anesthesia duration ranged from 20 to 240 minutes, with a median duration of 80 minutes. Mean IQ scores between exposed siblings (scores: full scale = 111; performance = 108; verbal = 111) and unexposed siblings (scores: full scale = 111; performance = 107; verbal = 111) were not statistically significantly different. Differences in mean IQ scores between sibling pairs were: full scale = -0.2 (95% CI, -2.6 to 2.9); performance = 0.5 (95% CI, -2.7 to 3.7); and verbal = -0.5 (95% CI, -3.2 to 2.2). No statistically significant differences in mean scores were found between sibling pairs in memory/learning, motor/processing speed, visuospatial function, attention, executive function, language, or behavior. Among healthy children with a single anesthesia exposure before age 36 months, compared with healthy siblings with no anesthesia exposure, there were no statistically significant differences in IQ scores in later childhood. Further study of repeated exposure, prolonged exposure, and vulnerable subgroups is needed.

Prospective Studies

Humans

Child, Preschool

Infant

Male

Anesthesia, General - adverse effects

Cognition - drug effects

Intelligence Tests

Hernia, Inguinal - surgery

Time Factors

Adolescent

Female

Child Development - drug effects

Retrospective Studies

Child

Cohort Studies

Siblings

Details

Title: Subtitle: Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood
Creators: Lena S Sun - Morgan Stanley Children's Hospital-New York Presbyterian, Columbia University Medical Center, New York, New York
Guohua Li - Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York
Tonya L K Miller - Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
Cynthia Salorio - Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Mary W Byrne - School of Nursing and College of Physicians and Surgeons, Columbia University, New York, New York
David C Bellinger - Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
Caleb Ing - Morgan Stanley Children's Hospital-New York Presbyterian, Columbia University Medical Center, New York, New York
Raymond Park - Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
Jerilynn Radcliffe - Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Stephen R Hays - Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
Charles J DiMaggio - New York University School of Medicine, New York, New York
Timothy J Cooper - Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
Virginia Rauh - Mailman School of Public Health, Columbia University, New York, New York
Lynne G Maxwell - Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Ahrim Youn - Mailman School of Public Health, Columbia University, New York, New York
Francis X McGowan - Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Resource Type: Journal article
Publication Details: JAMA : the journal of the American Medical Association, Vol.315(21), pp.2312-2320
DOI: 10.1001/jama.2016.6967
PMID: 27272582
PMCID: PMC5316422
NLM abbreviation: JAMA
ISSN: 0098-7484
eISSN: 1538-3598
Publisher: United States
Grant note: HHSF223200810036C / PHS HHS R49 CE002096 / NCIPC CDC HHS R34 HD060741 / NICHD NIH HHS U54 HD090255 / NICHD NIH HHS UL1 TR000040 / NCATS NIH HHS R01 HD084566 / NICHD NIH HHS
Language: English
Date published: 06/07/2016
Academic Unit: Stead Family Department of Pediatrics; Anesthesia
Record Identifier: 9984007170402771

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