Anesthesia for Cesarean Delivery and Learning Disabilities in a Population-based Birth Cohort

Abstract

T he impact of obstetric anesthesia on short and long-term behavior and development of a neonate/child is not thoroughly understood. In animal studies, exposure of fetuses/neonates to anesthetics administered to the mother causes histopathologic changes in the brain; even single, relatively brief administrations may be associated with a diminished capacity to retain learned behavior and/or abnormal behaviors resembling autism. The significance of this in humans is not clear, but the authors of this study recently showed that repeated (not single) exposures to anesthesia before the age of 4 years may double the risk of learning disabilities (LD) in a child. Using data from the same population-based birth cohort, they examined the possible association between fetal exposure to anesthesia during cesarean delivery (CS) and the subsequent development of LD in the child.Records of all children born in Rochester, Minnesota, between January 1, 1976 and December 31, 1982 to women living in one county school district (n = 8548) were reviewed. Those still living in the district at 5 years of age (n = 5718) were identified for the cohort. School, medical, and Reading Center/ Dyslexia Institute records were used to identify those with a potential LD [n = 1510 (26%)]. Finally, children meeting criteria based on standard measures of intelligent quotient and/or achievement within the same calendar year and before the age of 19 years having at least 1 of 3 LD (reading, written language, and math disorders) were considered cases.From the total possible subjects, exclusion of 19 children with severe mental retardation and 379 with authorization issues left the cohort with 5320 children; 4823 (90.7%) delivered vaginally, 193 (3.6%) by CS with general anesthesia (most including sodium thiopental, nitrous oxide, and potent inhalational anesthetics), and 304 (5.7%) by CS with regional anesthesia. Mean exposures to anesthetics were: epidural, 63.5 minutes; spinal, 21 minutes; and general, 14 minutes. Among 921 (17.3%) actual LD cases, incidence for children whose mothers delivered vaginally was 20.8% versus 19.4% for children delivered through CS with general anesthesia and 15.4% for children born through CS with regional anesthesia. With unadjusted proportional hazard regression, the incidence of LD was not increased in children born through CS compared with those born through vaginal delivery (overall, P = 0.135). However, after adjusting for risk factors for LD, the data suggested the risk of LD may be decreased in children delivered through CS under regional anesthesia compared with those delivered vaginally. The authors concluded that these results suggest that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopment. As children born by CS under regional anesthesia had a lower incidence of LD than the other 2 groups, they hypothesize that regional anesthesia for CS may attenuate the neonatal stress response to delivery sufficiently to have significant effects on later neural development. Li...

Long-term Differences in Language and Cognitive Function After Childhood Exposure to Anesthesia

“…This is in contrast to earlier studies finding no evidence of an association using broad-based summary scores, but in line with more recent data finding exposure to anesthesia associated with learning disability and receipt of individualized education programs for speech/language impairment. 13,15,16,19,20 Our findings may play an important role in directing future studies by identifying deficits in specific neuropsychological domains associated with anesthetic exposure. It is also noteworthy that the outcomes of language and reasoning cannot be easily assessed in the animal model, which emphasizes the importance of studies in humans.…”

“…In the past, outcomes such as diagnostic codes, academic performance, standardized testing, school and medical records, and parent and teacher surveys have been used. [13][14][15][16][17][18]20 Although some of these studies have found differences between exposed and unexposed children, directly administered neuropsychological assessments may have increased sensitivity to capture subtle effects that may be difficult to detect clinically. Neurodevelopmental studies of lead, pesticides, and other potential neurotoxins have similarly found that appropriate assessment tools are critical in documenting the effects of exposure.…”

“…12 Findings from clinical studies are mixed, with some studies showing a twofold increase in cognitive disability in children with anesthetic exposure, whereas others show no association. [13][14][15][16][17][18][19][20] In studies demonstrating an association of anesthesia with disability, only children with multiple anesthetic exposures have been associated with deficits, but an effect with a single exposure has not been identified. 14,18,20 These clinical studies have used International Classification of Diseases, 9th Revision diagnosis codes, standardized tests, and evaluations by parents and teachers as outcome measures, but none to date has used a battery of multiple directly assessed neuropsychological outcome measures.…”

Czy rzeczywiście znany jest efekt farmakodynamiczny środków stosowanych podczas znieczulenia ogólnego u noworodków, niemowląt i dzieci? Przegląd eksperymentalnych i klinicznych badań dotyczących działania neurodegeneracyjnego

“…Interestingly, slightly milder disorders were found in children whose mothers underwent regional anaesthesia for Caesarean section. The authors suggest that short-term exposure to general anaesthetics does not affect long-term neurodevelopmental disorders [38]. Another retrospective cohort study encompassed a group of 5,357 children born in the years 1976-1982.…”

Anaesthesia and the developing brain

“…It was concluded in a study published by the Mayo Clinic in 2009, in which the impact of obstetric anaesthesia on learning disabilities in children aged five years and younger was assessed, that there was no evidence of harm following Caesarean and vaginal delivery. 15 A feasibility pilot study, published by a group from the Netherlands in the same year, assessed neurobehavioural development after a single incident of anaesthesia exposure before the age of six years by using a questionnaire for ages 1-14 years. The authors concluded that, taking into account the size of the study, there was no "indisputable evidence" against the use of anaesthesia in the young.…”