Haifeng Zhang1, Lili Du2, Zijing Du1, Hao Jiang1, Dong Han3, Qingfeng Li1. 1. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China. 2. Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical College, Xuzhou, China. 3. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China. handong12000@163.com.
Abstract
OBJECTIVE: Many studies have been done to seek the relationship between general anesthesia and neurodevelopment in pediatrics. However, there is no unified conclusion, especially single anesthesia affecting a child before 3 and 4 years. The association between anesthesia and neurodevelopment is studied using a meta-analysis. METHODS: We summarized the currently available evidence by searching PubMed, EMBASE, and the Cochrane library over the past 10 years. An evaluation of neurodevelopment including learning disability, behavioral disorders, and cognitive problems was conducted. We estimated the synthesized hazard ratios (HR) and 95 % confidence interval (CI) according to inter-study heterogeneity and analyzed the factors for this association using meta-regression method. RESULTS: Thirteen eligible studies met the inclusion criteria. The neurodevelopment damage was associated with single general anesthesia before age of 4 (adjusted HR 1.28 95 % CI 1.10-1.45). The pooled adjusted HR was 1.17 (95 % CI 1.07-1.28, p = 0.001) before 4 years old after the influence analysis and the adjusted HR was 1.18 (95 % CI 1.07-1.30, p = 0.001) before 3 years old. There was no significant difference between 3 and 4 years exposed to single general anesthesia (HR3/HR4 = 1.008, p = 0.9). Due to limitations of retrospective studies, prospective investigations are needed to determine whether anesthesia is causative. CONCLUSIONS: The current evidence suggests a modestly elevated risk of neurodevelopmental disorders exists in children near 3 years of age. A single general anesthesia is relatively safe after 3 years, as the outcome is very close before 3 and 4 years old.
OBJECTIVE: Many studies have been done to seek the relationship between general anesthesia and neurodevelopment in pediatrics. However, there is no unified conclusion, especially single anesthesia affecting a child before 3 and 4 years. The association between anesthesia and neurodevelopment is studied using a meta-analysis. METHODS: We summarized the currently available evidence by searching PubMed, EMBASE, and the Cochrane library over the past 10 years. An evaluation of neurodevelopment including learning disability, behavioral disorders, and cognitive problems was conducted. We estimated the synthesized hazard ratios (HR) and 95 % confidence interval (CI) according to inter-study heterogeneity and analyzed the factors for this association using meta-regression method. RESULTS: Thirteen eligible studies met the inclusion criteria. The neurodevelopment damage was associated with single general anesthesia before age of 4 (adjusted HR 1.28 95 % CI 1.10-1.45). The pooled adjusted HR was 1.17 (95 % CI 1.07-1.28, p = 0.001) before 4 years old after the influence analysis and the adjusted HR was 1.18 (95 % CI 1.07-1.30, p = 0.001) before 3 years old. There was no significant difference between 3 and 4 years exposed to single general anesthesia (HR3/HR4 = 1.008, p = 0.9). Due to limitations of retrospective studies, prospective investigations are needed to determine whether anesthesia is causative. CONCLUSIONS: The current evidence suggests a modestly elevated risk of neurodevelopmental disorders exists in children near 3 years of age. A single general anesthesia is relatively safe after 3 years, as the outcome is very close before 3 and 4 years old.
Entities:
Keywords:
Anesthesia, general anesthetics; Cohort studies; Infant; Neurodevelopmental; Newborn; Pediatrics
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