[PEDIATRICS] Anesthesia administered prior to age 3 shown to be associated with cognitive deficits later in life

We know that animals in infancy that are exposed to anesthetics develop cognitive deficiencies later in life. Studies in children have been mixed, and moreover only children with multiple anesthetic exposures have been associated with deficits (vs. single exposure).

A new report in Pediatrics uses directly administered neuropsychological assessments, for the first time in a study on the topic, in order to analyze the association between exposure to anesthesia in children and language, cognitive, motor and behavioral effects. The study population was limited to anesthetics administered to children <3 years old and the outcomes were assessed at age 10 vs. control (non-anesthetized) children. Data were obtained retrospectively from the Western Australian Pregnancy Cohort Study (aka the RAINE study).

Key results: children exposed to anesthesia before age 3 had an increased long-term risk of clinical deficit in receptive and expressive language (CELF-R: adjusted risk ratio [aRR], 1.87; 95% confidence interval [CI], 1.20–2.93, CELF-E: aRR, 1.72; 95% CI, 1.12–2.64), as well as abstract reasoning (CPM: aRR, 1.69; 95% CI, 1.13–2.53). Data were adjusted for differences in demographics between groups.

In addition, the authors also found that children who only had a single exposure to anesthesia also had a significantly increased risk of deficit in receptive language and abstract reasoning – this is a new finding and not previously shown in the literature.

As a retrospective study the report invites the typical limitations – including that of establishing causality – although the cognitive testing was performed prospectively.  Perhaps more important to mention is the lack of access to detailed medical records of the patients, which may invite confounding in that the children who are anesthetized for surgery may be innately different from those not. However comorbid conditions could not be assessed.

Click here to read the report in Pediatrics.

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