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HomeAnaesthesiologyNo evidence that anaesthesia before 3-years impacts on child's IQ

No evidence that anaesthesia before 3-years impacts on child's IQ

A Mayo Clinic study finds no evidence that children given anaesthesia before their third birthdays have lower IQs than those who did not have it. A more complex picture emerges among people who had anaesthesia several times as small children: Although their intelligence is comparable, they score modestly lower on tests measuring fine motor skills, and their parents are more likely to report behavioural and learning problems.

The US Food and Drug Administration warned in 2016 that prolonged or repeated sedation before age 3 may affect brain development. The warning was based largely on data from animals, which may or may not apply to children.

Mayo researchers studied 997 people born from 1994 through 2007 in Olmsted County, Minnesota, the home of Mayo Clinic's Rochester campus. They were grouped according to the anaesthesia exposures they had before their third birthdays: 206 had two or more; 380 had one; and 411 had none. Ear, nose and throat procedures were the most common surgeries.

The researchers used the Rochester Epidemiology Project medical records database, brain function testing at ages 8-12 or 15-20, and parent reports to assess behaviour and brain function. Beyond their anaesthesia exposure, the three groups of patients were matched to be as similar as possible.

Intelligence, memory, and several other measures of brain function were similar among the groups. However, those with multiple exposures to anaesthesia had modest declines in fine motor skills, such as the ability to draw figures with a pencil, and how quickly they processed information when reading. Their parents reported more learning and behavioural problems, such as difficulty reading; behaviours consistent with attention deficit hyperactivity disorder; breaking rules; or displaying aggression, anxiety or social withdrawal.

Parents whose children had anaesthesia once under age 3 reported more problems with mental skills known as executive functions – skills that help with memory, impulse control, planning and flexibility – but not with other behaviours.

"For the majority of kids undergoing surgery, the results overall are reassuring," says lead author Dr David Warner, a paediatric anaesthesiologist at Mayo Clinic Children's Centre. "About 80% of kids who need surgery under age 3 only need one, and it's relatively brief."

Several other studies also show little evidence that a single anaesthetic is associated with significant harm.

"Although we do have some concerns about the children who are receiving multiple anaesthetics, it's important to note that our results don't allow us to conclude that anaesthesia itself is causing problems," Warner says, adding that other factors, such as the conditions that make surgery necessary, could contribute. "However, the fact that we found some problems in some of these children means that research in this area needs to continue, including further analysis of our data."

In the meantime, in most cases the benefit of surgery outweighs any risk, Warner says. However, the potential for problems may need to be part of the decision-making process when parents and surgeons discuss surgery, he adds.

Abstract
Background: Few studies of how exposure of children to anesthesia may affect neurodevelopment employ comprehensive neuropsychological assessments. This study tested the hypothesis that exposure to multiple, but not single, procedures requiring anesthesia before age 3 yr is associated with adverse neurodevelopmental outcomes.
Methods: Unexposed, singly exposed, and multiply exposed children born in Olmsted County, Minnesota, from 1994 to 2007 were sampled using a propensity-guided approach and underwent neuropsychological testing at ages 8 to 12 or 15 to 20 yr. The primary outcome was the Full-Scale intelligence quotient standard score of the Wechsler Abbreviated Scale of Intelligence. Secondary outcomes included individual domains from a comprehensive neuropsychological assessment and parent reports.
Results: In total, 997 children completed testing (411, 380, and 206 unexposed, singly exposed, and multiply exposed, respectively). The primary outcome of intelligence quotient did not differ significantly according to exposure status; multiply exposed and singly exposed children scoring 1.3 points (95% CI, −3.8 to 1.2; P = 0.32) and 0.5 points (95% CI, −2.8 to 1.9; P = 0.70) lower than unexposed children, respectively. For secondary outcomes, processing speed and fine motor abilities were decreased in multiply but not singly exposed children; other domains did not differ. The parents of multiply exposed children reported increased problems related to executive function, behavior, and reading.
Conclusions: Anesthesia exposure before age 3 yr was not associated with deficits in the primary outcome of general intelligence. Although secondary outcomes must be interpreted cautiously, they suggest the hypothesis that multiple, but not single, exposures are associated with a pattern of changes in specific neuropsychological domains that is associated with behavioral and learning difficulties.

Authors
David O Warner, Michael J Zaccariello, Slavica K Katusic, Darrell R Schroeder, Andrew C Hanson, Phillip J Schulte, Shonie L Buenvenida, Stephen J Gleich, Robert T Wilder, Juraj Sprung, Danqing Hu, Robert G Voigt, Merle G Paule, John J Chelonis, Randall P Flick

[link url="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-study-finds-no-evidence-that-anesthesia-in-young-children-lowers-intelligence/"]Mayo Clinic material[/link]
[link url="https://insights.ovid.com/crossref?an=00000542-900000000-96888"]Anaesthesiology abstract[/link]

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