Attention-deficit/hyperactivity disorder after early exposure to procedures requiring general anesthesia.
OBJECTIVE
To study the association between exposure to procedures performed under general anesthesia before age 2 years and development of attention-deficit/hyperactivity disorder (ADHD).


METHODS
Study patients included all children born between January 1, 1976, and December 31, 1982, in Rochester, MN, who remained in Rochester after age 5. Cases of ADHD diagnosed before age 19 years were identified by applying stringent research criteria. Cox proportional hazards regression assessed exposure to procedures requiring general anesthesia (none, 1, 2 or more) as a predictor of ADHD using a stratified analysis with strata based on a propensity score including comorbid health conditions.


RESULTS
Among the 5357 children analyzed, 341 ADHD cases were identified (estimated cumulative incidence, 7.6%; 95% confidence interval [CI], 6.8%-8.4%). For children with no postnatal exposure to procedures requiring anesthesia before the age of 2 years, the cumulative incidence of ADHD at age 19 years was 7.3% (95% CI, 6.5%-8.1%). For single and 2 or more exposures, the estimates were 10.7% ( 95% CI, 6.8%-14.4%) and 17.9% ( 95% CI, 7.2%-27.4%), respectively. After adjusting for gestational age, sex, birth weight, and comorbid health conditions, exposure to multiple (hazard ratio, 1.95; 95% CI, 1.03-3.71), but not single (hazard ratio,1.18; 95% CI, 0.79-1.77), procedures requiring general anesthesia was associated with an increased risk for ADHD.


CONCLUSIONS
Children repeatedly exposed to procedures requiring general anesthesia before age 2 years are at increased risk for the later development of ADHD even after adjusting for comorbidities.
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. sprung.juraj@mayo.edu
Juraj
J
Sprung
Randall P
RP
Flick
Slavica K
SK
Katusic
Robert C
RC
Colligan
William J
WJ
Barbaresi
Katarina
K
Bojanić
Tasha L
TL
Welch
Michael D
MD
Olson
Andrew C
AC
Hanson
Darrell R
DR
Schroeder
Robert T
RT
Wilder
David O
DO
Warner
D000293:Adolescent; D000768:Anesthesia, General / Q000009:adverse effects* / Q000706:statistics & numerical data*; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced* / Q000453:epidemiology*; D002648:Child; D002653:Child Behavior Disorders / Q000139:chemically induced / Q000453:epidemiology; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000139:chemically induced / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology