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Original Investigation
November 5, 2018

Influence of Surgical Procedures and General Anesthesia on Child Development Before Primary School Entry Among Matched Sibling Pairs

Author Affiliations
  • 1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 2Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
  • 3Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 4Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • 5Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
  • 6Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  • 7Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
  • 8Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
  • 9Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
JAMA Pediatr. Published online November 5, 2018. doi:10.1001/jamapediatrics.2018.3662
Key Points

Question  Are surgical procedures that require general anesthesia in early childhood associated with adverse child development outcomes?

Findings  This population-based study of 10 897 sibling pairs aged 5 to 6 years used the Early Development Instrument (a population-based measure of child development before primary school entry) data for Ontario, Canada, and found no differences in the adjusted odds of early developmental vulnerability or scores in major developmental domains between biological siblings when children were exposed to surgical procedures that require general anesthesia.

Meaning  After mitigating for biological vulnerability and environmental factors, exposure to surgical procedures that require general anesthesia in early childhood was not associated with increased risks of adverse child development outcomes.

Abstract

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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