Exposure to general anaesthesia in childhood and the subsequent risk of attention-deficit hyperactivity disorder: A meta-analysis of cohort studies

Sun, Jijun; Zhu, Chunyan; Jiang, Hai‐yin

doi:10.1016/j.ajp.2021.102708

Cited by 4 publications

(12 citation statements)

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“…GA is commonly used in young children for various surgical procedures (Rabbitts & Groenewald, 2020). There is a growing concern about the potential association between GA exposure in young children and the risk of developing ADHD (Arana Hakanson et al, 2020;Song et al, 2021Song et al, , 2023Sun et al, 2021;Tsai et al, 2018;Xu et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated this association, but the results have been mixed (Arana Hakanson et al, 2020;Song et al, 2021Song et al, , 2023Sprung et al, 2012;Sun et al, 2021;Tsai et al, 2018;Xu et al, 2019). Some studies have found a positive association between GA exposure and ADHD (Song et al, 2021(Song et al, , 2023Sprung et al, 2012;Sun et al, 2021;Tsai et al, 2018;Xu et al, 2019), whereas other have found no significant association (Arana Hakanson et al, 2020). In a recent study by a Korean team of 917,707 children, exposure to GA was found to be associated with an increased risk of ADHD and adverse outcomes in neurodevelopmental screening tests (Song et al, 2023).…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, the exposure of children to GA has become a topic of concern among parents, healthcare providers, and researchers. Nevertheless, there are inconsistent reports regarding the relationship between GA and poor neurodevelopment and behavioral disorders in children, which further warrants research (Ahn & Bang, 2020; Arana Hakanson, Fredriksson, & Engstrand Lilja, 2020; Song et al., 2023; Song, Li, Wang, & Niu, 2021; Sprung et al., 2012; Sun, Zhu, & Jiang, 2021; Tsai et al., 2018; Xu et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

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Early childhood general anesthesia and risk of Attention Deficit Hyperactivity Disorder

Sun

Chen

et al. 2023

Child Psychology Psychiatry

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BackgroundThe relationship between early childhood exposure to general anesthesia (GA) and the risk of developing Attention Deficit Hyperactivity Disorder (ADHD) is still uncertain and previous studies have presented conflicting results. This population‐based cohort study aimed to investigate the potential relationship between GA exposure and ADHD risk using propensity score matching (PSM) in a large sample size.MethodsThe study included 15,072 children aged 0–3 years who received GA and were hospitalized for more than 1 day in Taiwan from 2004 to 2014. The nonexposed group was randomly selected through 1:1 PSM from the Taiwan Maternal and Child Health Database (TMCHD). The primary objectives of this study were to determine the incidence rates (IR) and incidence rate ratios (IRR) of ADHD in the two cohorts, employing Poisson regression models.ResultsThe GA group and non‐GA group each comprised 7,536 patients. The IR of ADHD was higher in the GA group (122.45 per 10,000 person‐years) than in the non‐GA group (64.15 per 10,000 person‐years), and the IRR of ADHD in the GA group was 1.39 (95% CI: 1.26, 1.55). The study found that the number of times of exposure to GA, duration of exposure, male gender, and central nervous system surgery were significant risk factors for ADHD in the future.ConclusionsThis study's findings suggest that there is a significant correlation between early childhood exposure to GA and the risk of developing ADHD, and GA may be an important risk factor for ADHD in children undergoing surgery. The study also identified several risk factors for ADHD, including the number of times of exposure to GA, duration of exposure, male gender, and central nervous system surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early childhood general anesthesia and risk of Attention Deficit Hyperactivity Disorder

Sun

Chen

et al. 2023

Child Psychology Psychiatry

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“…Compared to children with other injuries or without injuries, children with severe traumatic brain injuries had an increased risk of being diagnosed with ADHD at less or more than 1 year, respectively, after the injuries [39]. Likewise, two or more exposures to general anesthesia were associated with an increased risk of ADHD in later life (relative risk RR = 1.84, 1.14–2.97) [40]. Blood lead level was associated with higher ADHD rates in children and adolescents [41].…”

Section: Resultsmentioning

confidence: 99%

A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder

Chaulagain,

Lyhmann,

Halmøy

et al. 2023

Eur. Psychiatr.

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Background There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. Methods We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. Results The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. Conclusions Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.

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“…In a study from 2020 that combined results encompassing the three above-mentioned clinical evidence (MASK, PANDA, and GAS) and others utilizing prospectively collected outcomes, single GA-exposed children were at a higher risk of behavioral problems but displayed no difference in general intelligence (Ing et al, 2021 ). One year later Sun and colleagues included seven studies adopting solely ADHD as an outcome measure (Sun et al, 2021 ). This meta-analysis indicated that the effect of GA on the risk of ADHD is dose- or duration dependent.…”

Section: Resultsmentioning

confidence: 99%

General anesthesia in children and long-term neurodevelopmental deficits: A systematic review

Xiao

Yang

et al. 2022

Front. Mol. Neurosci.

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BackgroundMillions of children experienced surgery procedures requiring general anesthesia (GA). Any potential neurodevelopmental risks of pediatric anesthesia can be a serious public health issue. Various animal studies have provided evidence that commonly used GA induced a variety of morphofunctional alterations in the developing brain of juvenile animals.MethodsWe conducted a systematic review to provide a brief overview of preclinical studies and summarize the existing clinical studies. Comprehensive literature searches of PubMed, EMBASE, CINAHL, OVID Medline, Web of Science, and the Cochrane Library were conducted using the relevant search terms “general anesthesia,” “neurocognitive outcome,” and “children.” We included studies investigating children who were exposed to single or multiple GA before 18, with long-term neurodevelopment outcomes evaluated after the exposure(s).ResultsSeventy-two clinical studies originating from 18 different countries published from 2000 to 2022 are included in this review, most of which are retrospective studies (n = 58). Two-thirds of studies (n = 48) provide evidence of negative neurocognitive effects after GA exposure in children. Neurodevelopmental outcomes are categorized into six domains: academics/achievement, cognition, development/behavior, diagnosis, brain studies, and others. Most studies focusing on children <7 years detected adverse neurocognitive effects following GA exposure, but not all studies consistently supported the prevailing view that younger children were at greater risk than senior ones. More times and longer duration of exposures to GA, and major surgeries may indicate a higher risk of negative outcomes.ConclusionBased on current studies, it is necessary to endeavor to limit the duration and numbers of anesthesia and the dose of anesthetic agents. For future studies, we require cohort studies with rich sources of data and appropriate outcome measures, and carefully designed and adequately powered clinical trials testing plausible interventions in relevant patient populations.

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Exposure to general anaesthesia in childhood and the subsequent risk of attention-deficit hyperactivity disorder: A meta-analysis of cohort studies

Cited by 4 publications

References 30 publications

Early childhood general anesthesia and risk of Attention Deficit Hyperactivity Disorder

Early childhood general anesthesia and risk of Attention Deficit Hyperactivity Disorder

A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder

General anesthesia in children and long-term neurodevelopmental deficits: A systematic review

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