General anesthesia for cesarean delivery and childhood neurodevelopmental and perinatal outcomes: a secondary analysis of a randomized controlled trial |
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| Affiliation: | 1. Center for Women’s Reproductive Health, University of Alabama at Birmingham, USA;2. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA;3. Department of Psychology, University of Alabama at Birmingham, USA;4. Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, USA;1. Department of Obstetrics, Oslo University Hospital, Ulleval, Oslo, Norway;2. Faculty of Medicine, University of Oslo, Norway;3. School of Health Care and Social Service, Tampere University of Applied Sciences, 33520 Tampere, Finland;1. Clinical Centre Vojvodina, Obstetrics and Gynecology Hospital, Department of Anesthesia, Novi Sad, Serbia;2. Clinical Centre Vojvodina, Neurosurgical Hospital, Novi Sad, Serbia;3. Department of Anesthesiology, University of Arizona, Tucson, AZ, USA;4. University of Novi Sad, Medical Faculty, Novi Sad, Serbia |
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| Abstract: | BackgroundIn 2016, the U.S. Food and Drug Administration expressed concern that neurodevelopment may be negatively affected by anesthesia or sedation exposure in pregnancy or before three years of age. We examined the association between general anesthesia at the time of cesarean delivery and early childhood neurodevelopment.MethodsA secondary analysis of a multicenter randomized controlled trial assessing magnesium for prevention of cerebral palsy in infants at risk for preterm delivery. Exposure was general compared to neuraxial anesthesia. The primary outcome was motor or mental delay at two years of age, assessed by Bayley Scales of Infant Development II (BSIDII). Secondary outcomes included BSIDII subdomains and perinatal outcomes. Multivariable logistic regression models were performed to control for confounders.ResultsOf 557 women undergoing cesarean delivery, 119 (21%) received general anesthesia. There were no differences in the primary composite outcome of developmental delay (aOR 0.93, 95% CI 0.61 to 1.43) or the BSIDII subdomains of mild, moderate, or severe mental delay, or mild or moderate motor delay. Severe motor delay was more common among infants exposed to general anesthesia (aOR 1.98, 95% CI 1.06 to 3.69). Infants exposed to general anesthesia had longer neonatal intensive care stays (51 vs 37 days, P=0.010).ConclusionsGeneral anesthesia for cesarean delivery was not associated with overall neurodevelopmental delay at two years of age, except for greater odds of severe motor delay. Future studies should evaluate this finding, as well as the impact on neurodevelopment of longer or multiple anesthetic exposures across all gestational ages. |
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| Keywords: | General anesthesia Neurodevelopment Motor delay Psychomotor delay |
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