610: Effect of general anesthesia at time of cesarean delivery on perinatal outcomes and childhood neurodevelopment

Abstract

In 2016, the FDA expressed concern that general anesthesia or sedation exposure in pregnancy or before 3 years of age may impact pediatric neurodevelopment and called for further research examining the impact of anesthesia, including single, short exposures. We examine the impact of general anesthesia (GA) during cesarean delivery (CD) on neurodevelopment at two years of age among infants born preterm. Secondary analysis of a multicenter RCT assessing magnesium for prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton, non-anomalous infant < 37wks by CD. The exposure of interest was general anesthesia. The primary outcome was mild to moderate developmental delay at 24 mos by Bayley Scales of Infant Development II (BSID). Secondary outcomes were BSID subdomains, periventricular leukomalacia, seizures, abnormal tone, hypotension, ventilator need, duration of oxygen use, and use of visual aids. Chi square, Fisher Exact, student’s t-test, Wilcoxon Rank Sum tests, and multivariable logistic regression models were performed. Of 557 women, 119 (21%) received GA. Women receiving GA were more likely to be unmarried, non-white, delivering more preterm (28.6 vs 29.7 wks, p< 0.01), undergoing CD for fetal distress (49% vs 36%, p=0.01), and in preterm labor >4cm (11% vs 3%, p< 0.01). Betamethasone and magnesium exposure were similar between groups, as was substance use. Mild to moderate developmental delay was not increased in those exposed to GA (Table). When BSID subdomains were analyzed individually, nominal increases in mild and moderate mental delay among infants exposed to GA did not persist after controlling for significant variables, including gestational age at delivery. Secondary outcomes did not differ significantly between groups. General anesthesia at time of CD does not appear to increase the risk of neurodevelopmental delay at two years in infants born preterm. Future studies should evaluate the impact of longer or multiple anesthetic exposures on neurodevelopment among all infants.