title: Exposure to general anesthesia in early life and the risk of attention deficit/hyperactivity disorder development: a nationwide, retrospective matched-cohort study.
abstract: BACKGROUND
  Postnatal exposure to anesthetics can cause neural apoptosis and degeneration in animals, but results from studies conducted on humans were discordant. Previous studies contained no information on the relationship between neurobehavioural disorders and anesthesia exposure in Asian children. We conducted a retrospective matched-cohort study in Taiwan to investigate the association of early life anesthesia exposure with risk of attention deficit/hyperactivity disorder (ADHD).
  
  
  METHODS
  Data were obtained from the National Health Insurance Research Database of Taiwan. Children born between January 1, 2001 and December 31, 2005 were included. Each child with anesthesia exposure before 3 years of age was matched to four unexposed children. Observation was concluded on December 31, 2010. Proportional hazards regression was used to assess the association of anesthesia exposure with ADHD. Analyses were also made based on exposure number and age at the time of first exposure.
  
  
  RESULTS
  This matched-cohort comprised of 16 465 children, among which 3293 were exposed to general anesthesia before age 3 years. The adjusted hazard ratio of developing ADHD was 1.06 (95% CI: 0.86,1.31) for general anesthesia exposure. The adjusted hazard ratio of developing ADHD for single and multiple exposures were 1.11 (95% CI: 0.88, 1.41) and 0.96 (95% CI: 0.71,1.31), respectively. No trend of increasing risk was noted based on age at the time of first exposure.
  
  
  CONCLUSIONS
  Exposure to general anesthesia before 3 years of age was not associated with ADHD.
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Anesthesiology, Chung Shan Medical University and Hospital, Taichung, Taiwan.
authors.forename: Wen-Ru
authors.initials: WR
authors.lastname: Ko
authors.forename: Yung-Po
authors.initials: YP
authors.lastname: Liaw
authors.forename: Jing-Yang
authors.initials: JY
authors.lastname: Huang
authors.forename: De-Hui
authors.initials: DH
authors.lastname: Zhao
authors.forename: Hui-Chin
authors.initials: HC
authors.lastname: Chang
authors.forename: Pei-Chieh
authors.initials: PC
authors.lastname: Ko
authors.forename: Shiou-Rung
authors.initials: SR
authors.lastname: Jan
authors.forename: Oswald Ndi
authors.initials: ON
authors.lastname: Nfor
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Chiang
authors.forename: Long-Yau
authors.initials: LY
authors.lastname: Lin
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced / Q000453:epidemiology*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D013624:Taiwan / Q000453:epidemiology
keywords: attention deficit disorder with hyperactivity; child; cohort studies; general anesthesia; health insurance