Exposure to general anesthesia before 4 years of age did not affect growth and development: A nationwide retrospective cohort study using an early childhood health screening database

ABSTRACT Introduction: There is little evidence that anesthetics are associated with neurotoxicity in children. In this study, we used a nationwide database to evaluate the association between general anesthesia and attention deficit/hyperactivity disorder (ADHD) in pediatric patients. Methods: We retrospectively analyzed data from the National Health Insurance Service-infant medical checkup cohort database. We included all pediatric patients born in 2008 and 2009 and classified them into two groups according to their history of exposure to general anesthesia. Group G included pediatric patients who had been exposed to general anesthesia at least once before 4 years of age. Group O included a 1:4 matched cohort based on birth weight, sex, and income decile. The primary outcome was the prevalence of ADHD. Secondary outcomes included head circumference, height, weight, visual and auditory development. Results: Among 17,451 participants, 315 (1.8%) underwent general anesthesia before 4 years of age. After propensity score matching, 1259 participants were selected in group O, with no significant differences between the groups in terms of birth weight, sex, income decile, and prematurity. Among all 1574 participants, 17 (1.08%) were diagnosed with ADHD, without a significant difference between the two groups ( P = 0.33). There was also no significant difference in head circumference, height, weight, auditory and visual development ( P = 0.43, 0.45, 0.49, 0.32, 0.13, respectively). Conclusion: Children who underwent surgery requiring general anesthesia before 4 years of age did not have an increased risk of ADHD or developmental disorders. Future studies should assess the association between duration of surgery and occurrence of ADHD. Highlights: