Children Exposed to General Anaesthetic Do Poorer on Numeracy, Literacy Tests

Exposure to general anaesthetic up to age 4 years raises the risk of poor child development and reduced literacy and numeracy as measured by school tests, according to a study published in Pediatric Anesthesia.

The study included 211,978 children who were born in New South Wales, Australia at 37-plus weeks’ gestation without major congenital anomalies or neurodevelopmental disability. Of these, researchers had data on their school entry developmental assessment in 2009, 2012, or their Grade-3 school test results in 2008-2014.

The researchers compared the developmental and school results of children exposed to general anaesthesia during hospital procedures (37,880) up to 48 months of age to same-aged children with no exposure to general anaesthesia or hospitalisation (197,301).

Compared to children unexposed to general anaesthesia, those exposed to general anaesthesia had a 17% increased risk of poor child development, a 34% increased risk of lower numeracy scores on school tests, and a 23% increased risk of lower reading scores on school tests.

When the researchers restricted their analyses to children who had had only 1 hospitalisation involving a procedure requiring general anaesthesia, they found no increased risk for poor development or reduced reading scores, however the risk of poor numeracy scores remained.

“There are many reasons why a child requires surgery or investigation, and, in some cases, this may be lifesaving or unavoidable,” said the study’s senior author Natasha Nassar, PhD, University of Sydney, New South Wales, Australia.

“For these children, our findings suggest that it is important to follow-up and monitor their literacy and numeracy skills when they reach school, and ensure early intervention, if required.”

Co-author Justin Skowno, MBChB, University of Sydney, said: “Determining exactly what is causing this effect is not easy.

“The children receiving a general anaesthetic in this study also had surgery, and often had other associated medical conditions.

“There are some procedures where alternative approaches or management may be possible, but the majority of surgeries in young infants and children cannot easily be postponed.”

“Parents can certainly discuss with their doctor and explore whether these procedures can be avoided, combined with other procedures, delayed to older ages or treated with alternatives to surgery, or other methods of sedation,” said Dr. Skowno.

The researchers say further investigation of the specific effects of general anaesthesia on numeracy skills, underlying health conditions that prompt the need for surgery or diagnostic procedures is required, particularly among children exposed to previous or long duration of general anaesthesia or with repeated hospitalisations.