General anesthesia exposure in infants not linked to impaired cognitive development

1. In this sibling matched cohort study, IQ scores in adolescence were comparable between infants exposed to general anesthesia before age 3 and unexposed siblings.

2. Secondary outcomes of cognition were also similar between these two groups.

Evidence Rating Level: 2 (Good)

Study Rundown: The central nervous system develops markedly throughout infancy, and there is concern that exposure to general anesthesia during this formative period may negatively impact cognition later in life. The Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) study tracked patients exposed to general anesthesia during hernia repair operations before 36 months of age, and tested their cognitive abilities alongside their unexposed siblings. This study found no difference in IQ between the two groups at 8 to 15 years of age. In addition, both groups had similar performance in tasks concerning memory, attention, visuospatial function, executive function, language, and behavior.

This study was unable to recruit many female patients—given the nature of the inclusion criteria—utilized many different anesthesia regimens, and only evaluated a small fraction of exposed infants later in life, factors which may reduce the reliability of the findings. However, the results are reassuring and more research focus on gaining a more comprehensive understanding of the neurocognitive effects of general anesthesia in pediatric populations.

Click to read the study in JAMA

Relevant Reading: Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial

In-Depth [prospective cohort]: A total of 9038 infants aged 0-36 months undergoing hernia repair were identified at 5 major academic hospitals. After excluding those who could not be contacted, did not have a matched sibling, or failed to meet inclusion criteria, 105 sibling pairs were followed prospectively. Neuropsychologists tested participants in a blinded manner using a battery of tests designed specifically for the PANDA study. The primary endpoint of the study was IQ between the ages of 8 and 15. There was no difference detected between siblings exposed to general anesthesia and their unexposed siblings (0.2 IQ point difference; 95%CI -2.6 to 2.9). There was no differences detected in performance (0.5; 95%CI -2.7 to 3.7) or verbal (-0.5; 95%CI -3.2 to 2.2) IQ sub-scores. Secondary endpoints were also similar between groups, including measures of verbal fluency, internalizing and externalizing behaviors, total problem behaviors, adaptive behavior, memory, learning, motor or processing speed, visuospatial function, attention, executive function, or other areas of adaptive behavior.

Image: PD

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