title: Risk of ADHD After Multiple Exposures to General Anesthesia: A Nationwide Retrospective Cohort Study.
abstract: To study the association between general anesthesia exposure before age 3 years and having a later ADHD diagnosis.
  
  
  
  In a birth cohort, data were collected from a nationwide population database for children born between 1997 and 1999 who were exposed to general anesthesia before their third birthday. Age- and gender-matched enrollees without general anesthesia exposure were taken as the comparison. Groups were compared to identify the incidence of ADHD after age 4 and anesthesia-related predictive factors.
  
  
  
  Among the 1,146 exposed children, 74 ADHD cases were identified, and 158 ADHD cases were identified in 3,438 matched controls. After adjusting for comorbid conditions and possible confounding factors, if exposure on more than one occasion or ≥3 hr, an increased likelihood of having a later ADHD diagnosis was found (HR, 1.71 and 2.43, respectively).
  
  
  
  Children with multiple or ≥3 hr general anesthesia exposures before age 3 years have an increased likelihood of a later ADHD diagnosis.
authors.affiliation: 1 Taichung Veterans General Hospital, Taiwan.
authors.forename: Chia-Jui
authors.initials: CJ
authors.lastname: Tsai
authors.affiliation: 2 Kaohsiung Medical University, Taiwan.|3 National Taiwan Normal University, Taipei, Taiwan.
authors.forename: Charles Tzu-Chi
authors.initials: CT
authors.lastname: Lee
authors.affiliation: 4 Chang Gung Memorial Hospital, Taoyuan, Taiwan.|5 Chang Gung University, Taoyuan, Taiwan.
authors.forename: Sophie Hsin-Yi
authors.initials: SH
authors.lastname: Liang
authors.affiliation: 6 Lu-Tung Christian Hospital, Changhua, Taiwan.
authors.forename: Pei-Jung
authors.initials: PJ
authors.lastname: Tsai
authors.affiliation: 5 Chang Gung University, Taoyuan, Taiwan.|7 Chiayi Chang Gung Memorial Hospital, Taiwan.
authors.forename: Vincent Chin-Hung
authors.initials: VC
authors.lastname: Chen
authors.affiliation: 8 King's College London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Gossop
mesh_terms: D017668:Age of Onset; D000768:Anesthesia, General / Q000009:adverse effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced* / Q000453:epidemiology*; D016022:Case-Control Studies; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D013624:Taiwan
keywords: ADHD; NHIRD; general anesthesia; risk