Anesthesia for Cesarean Delivery and Learning Disabilities in a Population-based Birth Cohort

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Anesthesiology (Impact Factor: 5.88). 09/2009; 111(2):302-10. DOI: 10.1097/ALN.0b013e3181adf481
Source: PubMed


Anesthetics administered to immature brains may cause histopathological changes and long-term behavioral abnormalities. The association between perinatal exposure to anesthetics during Cesarean delivery (CD) and development of learning disabilities (LD) was determined in a population-based birth cohort.
The educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minnesota from 1976-1982 and remaining in the community at age 5 were reviewed to identify those with LDs. Cox proportional hazards regression was used to compare rates of LD between children delivered vaginally and via CD (with general or regional anesthesia).
Of the 5,320 children in this cohort, 497 were delivered via CD (under general anesthesia n = 193, and regional anesthesia n = 304). The incidence of LD depended on mode of delivery (P = 0.050, adjusted for sex, birth weight, gestational age, exposure to anesthesia before age 4 yr, and maternal education). LD risk was similar in children delivered by vagina or CD with general anesthesia, but was reduced in children receiving CD with regional anesthesia (hazard ratio = 0.64, 95% confidence interval 0.44 to 0.92; P = 0.017 for comparison of CD under regional anesthesia compared to vaginal delivery).
Children exposed to general or regional anesthesia during CD are not more likely to develop LD compared to children delivered vaginally, suggesting that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopmental outcomes. The risk of LD may be lower in children delivered by CD whose mothers received regional anesthesia.

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Available from: Juraj Sprung, Jan 22, 2014
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    • "The authors suggested that dyslexia could be related to a disconnection syndrome, signaling candidate genes (DCDC2, KIAA0319, DYX1C1) associated with neuroanatomical alterations, involving both the white and the gray matter of a fronto-temporo-parietal network, suggestive of dysfunction in cortical connectivity. Several acquired factors have been also involved such as: childbirth dystocias, neonatal asphyxia, neonatal icterus, cardiorespiratory arrest, status epilepticus, low birth weight and preterm birth [7-9], smoker mother during pregnancy [10], exposure to more than 2 general anesthesia within the fourth year of life [11,12], parental history of alcoholism or substance abuse [13] and prenatal exposure to cocaine [14]. School, family and social context are also interweave with neurobiological and contribute to determine the multifactorial nature of LD. "
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