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Influence of surgical procedures and general anesthesia on child development before primary school entry among matched sibling pairs

O'Leary JD, Janus M, Duku E, Wijeysundera DN, To T, Li P, Maynes JT, Faraoni D, Crawford MW. JAMA Pediatr. 2019; 173(1):29-36. Epub 2018 Nov 5.


Importance — Substantial preclinical evidence suggests that the developing brain is susceptible to injury from anesthetic drugs. Findings from clinical studies of the neurotoxic effects of anesthesia are mixed, but these effects can be influenced by unmeasured confounding from biological and environmental risk and protective factors on child development.

Objective — To examine the association between surgical procedures that require general anesthesia before primary school entry and child development in biological siblings.

Design, Setting, and Participants — This retrospective sibling-matched cohort study included sibling pairs aged 5 to 6 years with the same birth mother who had early development instrument (EDI) data completed. The EDI is a population-based measure of child development that assesses children's readiness to learn in 5 major domains (physical health and well-being, social knowledge and competence, emotional health and maturity, language and cognitive development, and communication skills and general knowledge). All eligible children in public and catholic schools in Ontario, Canada, from 2004 through 2012 were included. Data were analyzed from December 13, 2017, through July 27, 2018.

Exposures — Surgical procedures that require general anesthesia from the date of birth to EDI completion.

Main Outcomes and Measures — Early developmental vulnerability, defined as any major domain of the EDI in the lowest 10th percentile of the Ontario population.

Results — Of the 187 226 eligible children for whom the EDI was completed, a total of 10 897 sibling pairs (21 794 children; 53.8% female; mean [SD] age, 5.7 [0.3] years) were subsequently identified, including 2346 with only 1 child exposed to surgery. No significant differences were found between exposed and unexposed children in early developmental vulnerability (697 of 3080 [22.6%] vs 3739 of 18 714 [20.0%]; adjusted odds ratio [AOR], 1.03; 95% CI, 0.98-1.14; p = .58) or for each of the 5 major EDI domains (AOR for language and cognitive development, 0.96 [95% CI, 0.80-1.14]; AOR for physical health and well-being, 1.09 [95% CI, 0.96-1.24]; AOR for social knowledge and competence, 0.98 [95% CI, 0.84-1.14]; AOR for emotional health and maturity, 0.98 [95% CI, 0.84-1.14]; and AOR for communication skills and general knowledge, 0.90 [95% CI, 0.77-1.05]), after adjusting for confounding factors (age at EDI completion, sex, mother's age at birth, and eldest sibling status).

Conclusions and Relevance — In this provincial cohort study, children who had surgical procedures that require general anesthesia before primary school entry were not found to be at increased risk of adverse child development outcomes compared with their biological siblings who did not have surgery. These findings further support that anesthesia exposure in early childhood is not associated with detectable adverse child development outcomes.

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