Effects Of Anesthesia And Surgery On The Neurodevelopment Assessment In Preschool Children

ObjectiveTo investigate the effects of anesthesia and surgery on neurodevelopment of preschool children in our hospital used Denver Development Screening Test?DDST?with a retrospective clinical cohort study in the real world.Among them,whether the frequency and cumulative duration of anesthesia exposures were the key factors was studied.At the same time,the related factors of preschool children's development were systematically analyzed,which could provide a basis for clinical research on early childhood cognitive protection.MethodsThe clinical retrospective cohort study was performed.A total of 445children aged 0⁶ years old,scheduled to undergo surgery in the Fourth Medical Center of Chinese PLA General Hospital from 1st May 2017 to 1st May2018 were enrolled and 168 children aged 0⁶ years old in kindergartens affiliated to our hospital at the same period were also enrolled as research subjects.According to anesthesia and surgery exposed in children,grouped as follows:Children who underwent anesthesia and surgery were included in the GA group?n=122?,while unexposed children in hospital were enrolled in the no-GA group?n=325?.Children in kindergartens who did not undergo anesthesia and surgery were enrolled in Na?ve group?n=166?to exclude the possible developmental abnormalities of children in hospital.The basic condition of children's physical development,the frequency of anesthesia,the duration of anesthesia exposure,and the family environment of children were all recorded.The DDST carried out for children by the professional before operation,and the DDST also conducted for kindergarten children by the same tester.The effects of anesthesia and surgery on the subsequent development of children aged 0⁶ years old were analyzed,and the correlation between the frenquecy and duration of anesthesia exposure and development was further explored.Meanwhile,the related influencing factors of children's development were also analyzed.Results?.Effects of anesthesia exposures on children's development???DDST results of preschool childrenFor the preschool children,the DDST positive rates in no-GA group and GA group were 6.5%and 12.3%,respectively.Compared with no-GA group,the DDST positive rate increased in GA group with significant difference?P=0.043?.Compared among the four domains of DDST separately,statistical difference was found only in terms of personal-social,those in GA group showed poor performance than in no-GA group?P=0.027?.???DDST results of children aged 0³ and 3⁶ years oldThe DDST positive rates in no-GA group and GA group were 3.9%and18.6%aged 0³ years old?including 3 years old?,respectively.The difference was statistically significant?P=0.019?.But no statistical difference was found on DDST positive rate among the three groups?Na?ve group,no-GA group and GA group?of children aged 3⁶ years old?P=0.642?.???Effects of anesthesia exposures in children's DDST resultsIn GA group,there was no increase in odds of early developmental vulnerability with increasing frequency of anesthesia exposure?P=0.780?.However,the DDST positive rate was significantly higher with longer cumulative duration of anesthesia exposure??3h?than that of<3h?18.7%vs 2.1%,P=0.007?.???Effects of gender in children's DDST resultsComparison within the group:The DDST positive rates in boys was higher than girls in Na?ve group and no-GA group,but there was no significant difference in each group?P=0.364,P=0.697?.The DDST positive rates of girls in the GA group was higher than that in boys,but the difference was not statistically significant?P=0.735?.Comparison between groups:The DDST positive rates in boys and girls in GA group were higher than those in no-GA and Na?ve group,respectively,but there was no significant difference between the three groups(P_male=0.451,Pfemale=0.121).?.Analysis of influencing factors related to children's development???Factors influencing the development of preschool childrenUnivariate analysis showed that positive DDST in preschool children was correlated with Body Mass Index?BMI?,anesthesia exposures,parental education and occupation,family types,housing status and the mode of delivery?all P<0.05?.In addition,further multivariate regression analysis showed that BMI,maternal occupation,housing status and the mode of delivery were influencing factors in preschool children?P values were 0.011;0.006;0.002;0.015,respectively?.Age stratification study found that the positive DDST in children aged 0³ years old was not related to anesthesia exposures,parental education and occupation,family types and the mode of delivery?all P>0.05?.But,the BMI,maternal occupation and housing status of children aged 3⁶years old were associated with positive DDST?P values were 0.002;0.008;0.000,respectively?.It is suggested that the exposure to anesthesia and surgical has a certain impact on the development of preschool children,but compared with other factors,it is not an independent influencing factor in children's development.???Factors influencing the development in each groupUnivariate and multivariate regression analysis verified that the positive DDST was correlated with the cumulative duration of anesthesia exposures,maternal occupation and the mode of delivery?P=0.038;0.020;0.004?in GA group,however,there was no significant correlated with the frequency of anesthesia exposure?P=0.780?;the positive DDST was correlated with BMI and housing status in unexposed children?including children in kindergarten??P=0.003;0.002?.It is suggested that the subsequent effects of anesthesia exposure on children in the early developmental stage may be multiple dimensions,rather than the single effect.???Factors influencing the development of children with different gendersUnivariate and multivariate regression analysis demonstrated that the positive DDST in boys aged 0⁶ years old was associated with maternal occupation and housing status?P=0.024;0.010?,while there were no significant influencing factors in girls aged 0⁶ years old?P>0.05?.It is suggested that gender was the import factors related to the development of preschool children.ConclusionsA retrospective clinical cohort study in the real world using the DDST found that undergoing anesthesia and surgery has the certain impact on the development of preschool children,mainly in the development of personal-social ability.Compared with frequency of anesthesia exposure,the duration of anesthesia and surgery?more than 3 hours?has greater impacts on children's development.In addition,exposure to anesthesia and surgery has more significant effects on the development of children before the age of 3 years old,and its influence gradually diminishes with age.Meanwhile,there was no significant difference in children with different genders.In the analysis of factors related to children's development,compared with children's BMI,family rental housing,mother's occupation and the mode of mother delivery,effects of anesthesia exposures to children's subsequent development were not be observed.In addition,the relevant influencing factors may vary depending on the age,anesthetic exposures and gender of the child.