Does General Anesthesia in Neonates Impair Long-Term Neurodevelopment?

Authors: McCann ME et al. 

Lancet 2019 Feb 16

Whether general anesthesia in neonates impairs long-term neurodevelopment and cognition remains uncertain.

In an international randomized, controlled trial in 28 neonatal centers, investigators evaluated intelligence and other neurodevelopment measures at age 5 years in 722 infants (mostly boys) who underwent herniorrhaphy during infancy with use of either conscious sedation or sevoflurane general anesthesia.

Participants had been born at >26 weeks’ gestational age and were <60 weeks’ postmenstrual age at time of surgery (mean postnatal age, 70 days). The median duration of general anesthesia was 54 minutes. The primary outcome was the full-scale intelligence quotient (FSIQ) score of the Wechsler Preschool and Primary Scale of Intelligence, third edition. A difference of <5 points in the mean FSIQ score was considered equivalence. Researchers conducting neurodevelopmental evaluations were blinded to sedation assignment.

The mean FSIQ was 99.08 in the conscious sedation group and 98.97 in the general anesthesia group, achieving equivalence. Verbal, performance, and processing speed composite scores were also equivalent. Other neurodevelopmental milestones were considered similar between groups. Parental report of neurodevelopmental disorder diagnosis in children was not significantly different between groups.