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Don’t delay young children’s surgery for fear of GA harms

Preschool GA not linked to higher risk of adverse child development outcomes

Louise Prime

Tuesday, 06 November 2018

Children who have had surgical procedures under general anaesthesia (GA) before school age are at no greater risk of adverse child development outcomes than those who haven’t had GA, research has shown. The authors of the study*, published in JAMA Pediatrics, said their findings support the view that surgery in early childhood should not be delayed for fear of neurologic injury from anaesthetic drugs – although it remains unknown whether or not they can be generalised to children with longer cumulative exposures to anaesthetic and sedative drugs.

The researchers, from Ontario, Canada, commented that substantial preclinical evidence suggests that the developing brain is susceptible to injury from anaesthetic drugs; but there have been mixed findings from clinical studies of the neurotoxic effects of anaesthesia, probably confounded by biological and environmental risk and protective factors on child development. So, they conducted a retrospective sibling-matched cohort study to examine the association between surgical procedures that require general anaesthesia before primary school entry and child development in biological siblings.

They analysed data on 10,897 eligible sibling pairs aged 5-6 years with the same birth mother who had Early Development Instrument (EDI) data completed – including 2,346 pairs in which only one of the children had been exposed to surgery.

They reported that, after adjusting for confounding factors (age at EDI completion, sex, mother’s age at birth, and eldest sibling status) they found no statistically significant differences between exposed and unexposed children in early developmental vulnerability (22.6% vs 20.0%, adjusted odds ratio (aOR), 1.03) or in each of the five major EDI domains: language and cognitive development, aOR 0.96; physical health and well-being, aOR 1.09; social knowledge and competence, aOR 0.98; emotional health and maturity, aOR 0.98; communication skills and general knowledge, aOR 0.90.

The study authors noted that because most children in the cohort underwent a single nonphysiologically complex surgical procedure, although the findings are generalisable to most children who undergo surgical procedures before primary school age, it remains unknown whether or not they can be applied to children with repeated or lengthy exposures to surgery and anaesthesia or other health care-related risk factors for altered neurodevelopment. Furthermore, because the study was observational it has limited ability to infer causation.

They concluded: “In this provincial cohort study, children who had surgical procedures that require general anaesthesia 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 anaesthesia exposure in early childhood is not associated with detectable adverse child development outcomes.”

They added: “Surgery in early childhood should not be delayed for consideration of neurologic injury due to anaesthetic drugs.”

*O’Leary JD, Janus M, Duku E, et al. Influence of surgical procedures and general anesthesia on child development before primary school entry among matched sibling pairs. JAMA Pediatr. Published online November 05, 2018. doi:10.1001/jamapediatrics.2018.3662.

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