title: Duration of exposure to cranial vault surgery: associations with neurodevelopment among children with single-suture craniosynostosis.
abstract: OBJECTIVE
  To evaluate associations between neurodevelopment and exposure to surgery and anesthetic agents in children with single-suture craniosynostosis (SSC).
  
  
  BACKGROUND
  Young children with SSC have unexplained neurodevelopmental delays. The possible contributions of factors related to cranial vault surgery - including anesthesia - have not been previously examined.
  
  
  METHODS
  Two anesthesiologists reviewed the surgical records of 89 infants (70 had complete data). Primary exposures were duration of surgery and anesthesia and total duration of inhaled anesthesia (at age 6 months on average). Outcomes were the cognitive and motor scores from the Bayley Scales of Infant Development-II and language scores from the Preschool Language Scale, 3rd edition, given at age 36 months. Linear regression using robust standard error estimates was performed, adjusting for age at surgery and suture site.
  
  
  RESULTS
  Anesthesia duration ranged from 155 to 547 min. For every 30-min increase in anesthesia duration, the estimated average decrease in developmental test scores ranged from 1.1 to 2.9 (P ranged from <0.001 to 0.30). Similar, but weaker findings were observed with surgery duration and total duration of inhaled anesthesia. Inverse relations between exposure amounts and neurodevelopment were stronger in children with nonsagittal synostosis.
  
  
  CONCLUSIONS
  Average neurodevelopmental scores were lower among children experiencing longer surgeries and higher exposures to inhaled anesthesia. These associations may be due to anesthesia exposure, nonspecific effects of surgery, or unmeasured variables that correlate with surgery duration. Further study of potential causal mechanisms is warranted.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Naumann
authors.forename: Charles M
authors.initials: CM
authors.lastname: Haberkern
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Pietila
authors.forename: Craig B
authors.initials: CB
authors.lastname: Birgfeld
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Starr
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Kapp-Simon
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hopper
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Speltz
mesh_terms: D000769:Anesthesia, Inhalation; D002675:Child, Preschool; D003398:Craniosynostoses / Q000150:complications* / Q000601:surgery*; D002658:Developmental Disabilities / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D061646:Operative Time; D012886:Skull / Q000601:surgery; D013537:Sutures; D013997:Time Factors