Wang Xin, Xu Zheng, Miao Chang-Hong
Department of Anesthesiology, Shanghai Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
PLoS One. 2014 Jan 20;9(1):e85760. doi: 10.1371/journal.pone.0085760. eCollection 2014.
Several epidemiological studies have been conducted to address the later effect of anesthesia on neurodevelopment in children. However, the results are still inconclusive.
We here conducted a systematic review and meta-analysis to summarize the currently available clinical and epidemiologic evidence on the association of anesthesia/surgery with neurodevelopmental outcomes in children by searching PubMed, EMBASE, and Web of Science database (from January-1 2000 to February-1, 2013). The evaluation of neurodevelopment includes language and learning disabilities, cognition, behavioral development, and academic performance. Both retrospective and prospective studies were included. Data were abstracted from seven eligible studies. We estimated the synthesized hazard ratios (HR) and 95% confidence interval (CI) according to inter-study heterogeneity.
The pooled HR for the association of anesthesia/surgery with an adverse behavioral or developmental outcome was 1.25 (95% CI, 1.13-1.38, P<0.001; random-effects model) in children undergoing the first anesthesia before the age of 4-year. Then we analyzed the factors for this association using meta-regression method. It showed that it was the number of times of exposure (HR = 1.75, 95% CI 1.31-2.33; P<0.001) rather than the time at exposure before 4-year (HR = 1.08, 95% CI 0.87-1.34 for the effect of per 1-year early exposure; P = 0.47) is a risk factor for neurodevelopmental impairment.
The current clinical evidence suggests modestly elevated risk of adverse neurodevelopmental outcomes in children who were exposed to anesthesia/surgery during early childhood, especially for those with multiple times of exposure. Due to limitation of retrospective studies, prospective investigations are needed to determine whether anesthesia/surgery is causative.
已经开展了多项流行病学研究，以探讨麻醉对儿童神经发育的后期影响。然而，结果仍无定论。
我们通过检索PubMed、EMBASE和科学引文索引数据库（从2000年1月1日至2013年2月1日），进行了一项系统综述和荟萃分析，以总结目前关于麻醉/手术与儿童神经发育结局之间关联的临床和流行病学证据。神经发育评估包括语言和学习障碍、认知、行为发育和学业成绩。纳入了回顾性和前瞻性研究。数据从七项符合条件的研究中提取。我们根据研究间的异质性估计了综合风险比（HR）和95%置信区间（CI）。
在4岁前接受首次麻醉的儿童中，麻醉/手术与不良行为或发育结局之间关联的合并HR为1.25（95%CI，1.13 - 1.38，P<0.001；随机效应模型）。然后我们使用荟萃回归方法分析了这种关联的因素。结果显示，是暴露次数（HR = 1.75，95%CI 1.31 - 2.33；P<0.001）而非4岁前的暴露时间（每提前1年暴露的效应，HR = 1.08，95%CI 0.87 - 1.34；P = 0.47）是神经发育受损的危险因素。
目前的临床证据表明，幼儿期接受麻醉/手术的儿童出现不良神经发育结局的风险略有升高，尤其是那些接受多次暴露的儿童。由于回顾性研究的局限性，需要进行前瞻性调查以确定麻醉/手术是否具有因果关系。
