Anesthesia before age 4
may have small effect on academics later
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[November 08, 2016]
By Kathryn Doyle
(Reuters Health) - Kids who are exposed to
surgical anesthesia before age four tend to have slightly lower school
grades at age 16 compared to other kids, but the difference is very
small and shouldn’t discourage parents from proceeding with necessary
surgeries, researchers say.
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The "low overall difference in academic performance after childhood
exposure to surgery is reassuring," they write in JAMA Pediatrics.
Studying the health and school records of more than 2 million
children born in Sweden between 1973 and 1993, the researchers
identified 33,000 children who had one surgery with anesthesia
before age four and 159,000 children who were similar in most ways
but had not had surgery or anesthesia before age 16.
On average, kids who’d had anesthesia had 0.41 percent lower school
grades at age 16 and 0.97 percent lower intelligence quotient (IQ)
scores at age 18.
Kids who had been exposed to anesthesia two or three times before
age four had school grades between one and two percent lower than
the comparison group of kids, the authors report.
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The difference was less than the impact of mother’s level of
education, gender and even month of birth, said lead author Dr. Pia
Glatz of Kalmar County Hospital in Sweden
Surgical management, the surgery itself and whatever caused the
surgery to be necessary in the first place may also have played a
role, although none of the children in this study had any serious
medical diagnoses, the authors note.
“No child is exposed to anesthesia and surgery unless it is
absolutely necessary,” Glatz told Reuters Health by email.
“Necessary conditions could be serious malformation, inguinal hernia
or urological conditions or ENT (ear-nose-throat) disorders with
hearing impairment.”
Based on recent animal studies, anesthesia exposure may change brain
development, but the doses and durations used in pediatric practice
have not caused structural changes in the brains of animals, she
said.
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“Based on these findings, families and caregivers should not
hesitate to provide surgery to young children when necessary, and
the magnitude of any adverse effect of anesthesia and surgery should
be interpreted in light of potential adverse effect by postponing
surgery,” Glatz said. “We need to further understand whether there
are certain high risk groups within the pediatric surgical
population and if so, we need to come up with preventive strategies
to avoid neurocognitive adverse effects in these children.”
The alternatives, i.e. postponing surgery, are most likely worse,
said Dr. Tom G. Hansen of Odense University Hospital in Denmark,
coauthor of an editorial accompanying the study.
“Surgeries in young children are urgent and important,” Hansen told
Reuters Health by email.
SOURCE: http://bit.ly/2fwfz02 JAMA Pediatrics, online November 7,
2016.
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