Children who are exposed to a long duration of general anesthesia up to the age of four are at greater risk for poor development as well as reduced reading and number skills as measured by school tests, according to a new Australian study published in the journal Pediatric Anesthesia.
General anesthesia affects the whole body and usually induces a loss of consciousness.
Among children who had undergone general anesthesia only one time, the researchers found no greater risk for poor development or reduced reading scores; however, the risk of poor numeracy scores remained.
The findings are based on a data-linkage study of 211,978 children born in New South Wales, Australia, at 37-plus weeks’ gestation without major congenital anomalies or neurodevelopmental disability. Of these, researchers had data on their school entry developmental assessment in 2009, 2012, or their grade-3 school test results in 2008-2014.
The research team compared the developmental and school results of children exposed to general anesthesia during hospital procedures (37,880) up to 48 months of age to same-aged children with no exposure to general anesthesia or hospitalization (197,301).
They discovered that, compared to unexposed children, those exposed to general anesthesia had a 17 percent increased risk of poor child development; 34 percent increased risk of lower numeracy scores on school tests; and 23 percent increased risk of lower reading scores on school tests.
When the researchers restricted their analyses to children who’d had only one hospitalization involving a procedure requiring general anesthesia, they found no increased risk for poor development or reduced reading scores; however, the risk of poor numeracy scores remained.
“There are many reasons why a child requires surgery or investigation, and, in some cases, this may be lifesaving or unavoidable,” said the study’s senior author, Professor Natasha Nassar of the University of Sydney. “For these children, our findings suggest that it is important to follow up and monitor their literacy and numeracy skills when they reach school, and ensure early intervention, if required.”
Further research is needed to understand the specific effects of general anesthesia on number skills, and to determine the potential role of the underlying health conditions that prompt the need for surgery or diagnostic procedures, particularly for children exposed to a long duration of general anesthesia or repeated hospitalizations.
“Determining exactly what is causing this effect is not easy,” said co-author Dr. Justin Skowno, a clinical lecturer at the University of Sydney and senior staff specialist in pediatric anesthesia at the Children’s Hospital, Westmead. “The children receiving a general anaesthetic in this study also had surgery, and often had other associated medical conditions.
“There are some procedures where alternative approaches or management may be possible, but the majority of surgeries in young infants and children cannot easily be postponed.”
“Parents can certainly discuss with their doctor and explore whether these procedures can be avoided, combined with other procedures, delayed to older ages or treated with alternatives to surgery, or other methods of sedation,” said Skowno.
Source: University of Sydney