Early Childhood General Anesthesia and Intellectual Disability: A Pediatric Cohort Study

Background: The neurotoxicity of general anesthesia (GA) on the developing human brain is a topic of ongoing debate. In this study, we aimed to assess the association between GA exposure before the age of 3 and the risk of intellectual disability (ID). Methods: : We enrolled individuals aged 0 to 3 years who underwent GA and were hospitalized for more than one day in Taiwan between January 2004 and December 2014. The study's final follow-up date was December 31, 2021. Results: : Using propensity score matching, we identified 15,036 infants and toddlers (7,518 in the GA group and 7,518 in the no GA group). Cox regression analysis showed that the adjusted hazard ratio (aHR) for ID in the GA group was 2.38 (95% confidence interval [CI]: 1.94-2.91) compared to the no GA group. Children who underwent GA once and more than once had aHRs of ID of 1.98 (95% CI: 1.03-2.64) and 2.86 (95% CI: 1.52-3.11), respectively. The aHRs of ID for children who received GA for less than 3 hours and 3 hours or more were 1.86 (95% CI: 1.13-1.98) and 2.77 (95% CI: 1.44-2.92), respectively. The IRs of ID for the no GA group and GA group were 15.34 and 36.05 per 10,000 person-years, respectively. Conclusions: : Our findings suggest that GA exposure before the age of 3 is associated with an increased risk of ID. Furthermore, age at first GA, duration of GA, and number of GA exposures are all significant risk factors for ID. Running Head ID Risk in Children after GA