Neurosurgical conditions and procedures in infancy are associated with mortality and academic performances in adolescence: a nationwide cohort study. Issue 2 (24th September 2014)

• Record Type: Journal Article
• Authors: Hansen, Tom G.; Pedersen, Jacob K.; Henneberg, Steen W.; Morton, Neil S.; Christensen, Kaare; Anderson, Brian
• Is Part Of: Paediatric anaesthesia. Volume 25:Issue 2(2015)
• Page Start: 186
• Page End: 192
• Publication Date: 2014-09-24
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12533
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" id="pan12533-abs-0001"> <title>Summary</title> <sec id="pan12533-sec-0001" sec-type="section"> <title>Background</title> <p>Few human cohort studies on anesthesia‐related neurotoxicity and the developing brain have focused on and compared specific surgeries and conditions. These studies cannot disentangle the effects of anesthesia from those of the surgery and underlying conditions. This study aimed at assessing the impact of specific neurosurgical conditions and procedures in infancy on mortality and academic achievements in adolescence.</p> </sec> <sec id="pan12533-sec-0002" sec-type="section"> <title>Methods</title> <p>A nationwide unselected register‐based follow‐up study of the Danish birth cohorts 1986–1990 compared academic performances of all children having undergone neurosurgeries as infants with a randomly selected, age‐matched 5% sample of the same cohorts. The two groups were compared regarding mortality prior to June 1st, 2006, average test scores at ninth grade, and finally the proportion of children not attaining test scores.</p> </sec> <sec id="pan12533-sec-0003" sec-type="section"> <title>Results</title> <p>The exposure group comprised 228 and the control group 14 698 individuals. Hydrocephalus (<italic>n</italic> = 130), craniotomy (<italic>n</italic> = 43), and myelomeningocele/encephalocele children (<italic>n</italic> = 55) had a higher mortality (18.5.0%, 18.6%, and 7.3%, respectively) vs controls (1.3%; <italic>P</italic> < 0.00001, <italic>P</italic> < 0.00001, and <italic>P</italic> = 0.0052, respectively). Average test scores were significantly lower than controls in hydrocephalus and craniotomy (<italic>P</italic> = 0.0043 and <italic>P</italic> = 0.0077) but not myelomeningocele/encephalocele children (<italic>P</italic> = 0.2785); the proportion of available test scores were significantly lower in all three groups (40.8%, 60.0%, and 67.3%, respectively) vs 86.8% in controls (<italic>P</italic> < 0.00001, <italic>P</italic> = 0.000077, and <italic>P</italic> = 0.000064).</p> </sec> <sec id="pan12533-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Neurosurgery in infancy was associated with high mortality and significantly impaired academic achievements in adolescence. When studying anesthesia‐related neurotoxicity and the developing brain, focus on specific surgeries/conditions is important. Pooling of major/minor conditions and major/minor surgeries should be avoided.</p> </sec> </abstract>