Abstract
Several studies in animal models have found that exposure to anesthetics in early life can cause cognitive dysfunction. Human studies show conflicting results and studies of cognitive function after anesthesia and neonatal surgery are scarce. The aim of this study was to investigate whether exposure to anesthesia and abdominal surgery during infancy was associated with cognitive dysfunction from the perspective of educational level, disposable income and attention deficit hyperactivity disorders (ADHD) in adolescent and adult individuals. A cohort study with patients born 1976 to 2002 that underwent abdominal surgery during infancy at a pediatric surgical center were matched by age, sex, and gestational age to ten randomly selected individuals from the Swedish Medical Birth Register. Individuals with chromosomal aberrations were excluded. Data on highest level of education and annual disposable income were attained from Statistics Sweden and the diagnosis of ADHD were retrieved from the Swedish National Patient Register. 485 individuals and 4835 controls were included. Median gestational age was 38 weeks (24-44) and median age at surgery was seven days (0-365). Three hundred sixty-six individuals (70.0%) underwent surgery during the neonatal period (< 44 gestational weeks). Median operating time was 80 minutes (10-430). The mean age at follow-up was 28 years. Fisher's exact test for highest level of education for the exposed and unexposed groups were respectively: university 35% and 33%, upper secondary 44% and 47%, compulsory 21% and 20% (p = 0.6718). The median disposable income was 177.7 versus 180.9 TSEK respectively (p = 0.7532). Exposed individuals had a prevalence of ADHD of 5.2% and unexposed 4.4% (p = 0.4191). This study shows that exposure to anesthesia and abdominal surgery during infancy is not associated with cognitive dysfunction from the perspective of educational level, disposable income and ADHD in adolescent and adult individuals. Further studies in larger cohorts at earlier gestational ages are needed to verify these findings.
Highlights
There is increasing concern that exposure to anesthesia and surgery in early childhood may increase the risk of later neurocognitive dysfunction and impaired educational level later in life [1, 2]
This study shows that exposure to anesthesia and abdominal surgery during infancy is not associated with cognitive dysfunction from the perspective of educational level, disposable income and attention deficit hyperactivity disorders (ADHD) in adolescent and adult individuals
Previous studies have found a doubling of the incidence of learning disabilities (LD) and attention deficit hyperactivity disorders (ADHD) after repeated exposure to general anesthesia before age 2–4 years [17,18,19]
Summary
There is increasing concern that exposure to anesthesia and surgery in early childhood may increase the risk of later neurocognitive dysfunction and impaired educational level later in life [1, 2]. 15 min of surgery designed to replicate an inguinal repair increased cell death in eight areas of the brain compared to anesthesia alone [13]. It is unclear whether these findings in animals can be extrapolated to children. Other studies found that exposure to general anesthesia and surgery in early-life had no association with adverse cognitive development [20, 21]. In a more recent study, an increased risk of ADHD was observed in children under age 5 with a single exposure to minor surgery requiring anesthesia [24]
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