Infant brain activity shows faster maturation after general anesthesia

New research published today in Proceedings of the National Academy of Sciences (PNAS) finds that prolonged and/or repeated exposure to gamma-aminobutyric acid (GABA) anesthetic agents (sevoflurane, propofol) for infants in the first two months of life resulted in an accelerated maturation of brain electrical activity patterns evoked by visual stimuli when recorded at 2-5 months of age, compared to infants who did not have early general anesthesia exposure. These findings may suggest the use of non-GABA-active anesthetics for the newborn age-range. To address such concerns, a large multicenter clinical trial (called TREX) is currently in progress using a combination of anesthetic agents in order to minimize exposure to GABA-active anesthetics. 

This paper is the fourth in a series emerging from a prospective longitudinal study known as the General Anesthesia and Brain Activity (GABA) Study, led by researchers at Boston Children's Hospital and Northeastern University. This newest paper is the primary translational publication of the GABA Study which is a first direct test in humans of a finding first made in mice that GABA triggers critical trajectories of brain development (Hensch et al, Science 1998; Hensch and Fagiolini, Nature 2000). The PNAS paper represents a proof-of-principle translation into human neurodevelopment from a well-established mechanism that governs neuroplasticity and development in animal models. This translational effort opens up new and important insights into individual variability in developmental timing toward serving a range of clinical populations.

 These findings build on previous work published in British Journal of Anesthesia-Open that found infants who received early and prolonged anesthesia exposure showed no statistically significant differences in a wide range of basic cognitive, language, motor, and behavioral domains when assessed at 10 months and 2–3 years old.

The accelerated visual cortical development at 2-3 and 4-5 months reported in the PNAS paper, combined with the reassuring neurodevelopmental findings at 10 months and 2-3 years in the BJA Open paper highlight the resilience of the highly plastic human infant nervous system. Further research is needed to explore the long-term impacts of prolonged and/or repeated early exposure by school age.