Early childhood exposure to anesthesia and risk of developmental and XXXX in a sibling birth cohort.

@entity1 @entity2359 @entity146
BACKGROUND: In vitro and in vivo studies of anesthetics have demonstrated serious @entity2359 effects on the developing brain. However, the clinical relevance of these findings to @entity1 undergoing anesthesia remains unclear. Using data from a sibling birth cohort, we assessed the association between exposure to anesthesia in the setting of surgery in @entity1 younger than 3 years and the risk of developmental and @entity146 . METHODS: We constructed a retrospective cohort of 10,450 siblings who were born between 1999 and 2005 and who were enrolled in the New York State Medicaid program. The exposed group was 304 @entity1 without a history of developmental or @entity146 who underwent surgery when they were younger than 3 years. The unexposed group was 10,146 @entity1 who did not receive any surgical procedures when they were younger than 3 years. Exposed @entity1 were entered into analysis at the date of surgery. Unexposed @entity1 were entered into analysis at age 10 months (the mean age at which exposed @entity1 underwent surgery). Both exposed and unexposed @entity1 were followed until diagnosis with a developmental or @entity146 , loss to follow-up, or the end of 2005. The association of exposure to anesthesia with subsequent developmental and @entity146 was assessed with both proportional hazards modeling, and pair-matched analysis. RESULTS: The incidence of developmental and @entity146 was 128.2 diagnoses per 1000 @entity1 -years for the exposed cohort and 56.3 diagnoses per 1000 @entity1 -years for the unexposed cohort. With adjustment for sex and history of birth-related medical complications, and clustering by sibling status, the estimated hazard ratio of developmental or @entity146 associated with any exposure to anesthesia when they were younger than 3 years was 1.6 (95% confidence interval [CI]: 1.4, 1.8). The risk increased from 1.1 (95% CI: 0.8, 1.4) for 1 operation to 2.9 (94% CI: 2.5, 3.1) for 2 operations and 4.0 (95% CI: 3.5, 4.5) for >= 3 operations. The relative risk in a matched analysis of 138 sibling pairs was 0.9 (95% CI: 0.6, 1.4). CONCLUSION: The risk of being subsequently diagnosed with developmental and @entity146 in @entity1 who were enrolled in a state Medicaid program and who had surgery when they were younger than 3 years was 60% greater than that of a similar group of siblings who did not undergo surgery. More tightly matched pairwise analyses indicate that the extent to which the excess risk is causally attributable to anesthesia or mediated by unmeasured factors remains to be determined.
