New research suggests that infants who undergo surgical procedures requiring general anesthesia in their first two years of life may be at increased risk of developing attention deficit hyperactivity disorder (ADHD) as they grow older.
The study included 5,357 children born in Rochester, Minnesota, between 1976 and 1982 and found that kids who underwent at least two such surgeries before their second birthday were roughly twice as likely as their peers to develop ADHD by the time they were 19.
Having a single surgical procedure did not appear to increase risk. In this group of infants, 7.3% of those with no exposure to anesthesia and 10.7% of those with just one exposure went on to develop ADHD - a difference the researchers deemed to be negligible, statistically speaking. However infants who had two or more experiences with anesthesia had a dramatically higher 17.9% chance of developing ADHD, according to the study, which appears this week in the journal Mayo Clinic Proceedings.
Senior study author David O. Warner, a pediatric anesthesiologist at the Mayo Clinic, in Rochester said the longer a child was unconscious, the greater the ADHD risk, which suggests that even several short exposures to anesthesia could heighten risk. However he adds that should not be unduly alarmed if their child requires general anesthesia. “All we can say is that we can't exclude that this could be a problem,” he says, noting that the findings do not prove cause and effect.
Researchers add that very few young children undergo surgery requiring general anesthesia, and those who do typically have serious medical conditions that can't be put off. These could include emergency hernia repair or to correct life-threatening abnormalities of the lungs or heart. The new findings should not dissuade parents or doctors from approving necessary surgery, says Peter J. Davis, anesthesiologist-in-chief at the Children's Hospital of Pittsburgh. “There is no data to suggest that kids who require surgery shouldn't have it,” says Davis, who was not involved in the study.
Concerns about the potential impact of general anesthesia on brain development first arose about 10 years ago, after studies showed that young animals exposed to anesthesia had brain changes that were associated with behavioral problems. A study published last year by Warner and his colleagues found that young children had double the risk of developing learning disabilities if they'd been exposed to multiple rounds of general anesthesia.
The new study implies the same pattern might hold for ADHD, although a number of major caveats apply. Only 350 children - less than 1% of the study participants - were put under for a surgical procedure, which is a small sample from which to draw conclusions. And more than two-thirds of the children needing surgery were boys, who are already at triple the risk for ADHD than girls. In addition, most of the surgeries, which took place in the late 1970s and early 1980s, involved the anesthetic halothane, which is no longer used. Finally, not all of the children received an ADHD diagnosis from a doctor. The researchers identified most ADHD cases by piecing together detailed school and medical records.
“We need to do more work to confirm whether this is really a problem in children or not…We can't exclude there is a problem, but we also haven't determined there is a problem,” Warner said.
In an editorial accompanying the study, Dr. Deborah Culley of Harvard Medical School in Boston wrote that the known benefits of surgery in infants and young children should outweigh an unproven risk. “The decision to proceed with surgery with anesthesia in an infant is best made based on what is known about the indications for-- and benefits of - the procedure and general anesthetic, rather than what is unknown but feared,” she wrote. She also added that doctors should take certain precautions, such as minimizing how long an infant is exposed to anesthesia.
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