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Effects of anaesthetic drugs on the developing brain in children less than 1 year of age: an epidemiological study
Author(s) -
Hansen T.G.,
Pedersen D.A.,
Henneberg S.W.,
Morton N.S.,
Christensen K.
Publication year - 2009
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2009.03043_7.x
Subject(s) - medicine , epidemiology , danish , population , public health , record linkage , disease , pediatrics , family medicine , environmental health , pathology , philosophy , linguistics
Introduction: Each year millions of neonates, infants and young children worldwide are exposed to anaesthetic drugs. The last 5 years concerns have been raised regarding a possible association of anaesthesia and neuro‐degeneration in young children, which represents an enormous potential burden to public health. Animal data is compelling and involves a variety of anaesthetic drugs, settings and species, including most recently primates. Implicated are n‐methyl‐d‐aspartate receptor antagonists and γ‐amino‐butyric acid agonists, including most of the commonly used anaesthetics for both children and adults. However, as yet, it is not clear whether the effects observed in animals are clinical relevant in humans [1]. The scientific approach to solve this question is difficult. One approach is the use of epidemiological methods, which have proven in many setting to be powerful tools for exploring the relationship between exposure and disease. Methods: We are currently conducting an epidemiological study in Denmark comparing the educational achievement of all children operated before the age of 1 year during the period 1977–1990, ( n = 45.000+) to the background Danish population. The study, which has been approved by the Danish Data Protection Agency, is based on linkage of a series of available registries. The Danish civil registration system identifies individuals by unique social security numbers, which can be linked to a number of thematically organized population databases, called registers. Information from three registers is used: (1) the Danish Demographic Database, which includes information on parental identities, deaths, migrations, adoptions and education, (2) the National Hospital Discharge Register, which includes information on overnight hospital stays for non‐psychiatric illnesses and (3) the Register of Compulsory School Completion Assessment and Test Scores, which is compiled from school reports by the Ministry of Education (at ninth grade, aged 15–16 years). The primary outcome in this study is academic achievements rather than IQ. The use of this cohort has several strengths: it is of unprecedented size, it is population‐based, and the important covariates such as: age, gestational age, birth weight, parental age and parental education are available for practically all participants in the study. Discussion: The data is currently being analyzed and will be presented at the 2009 APA Meeting in Brighton, as will pitfalls and strengths of epidemiological studies over randomized clinical studies for addressing this paediatric anaesthetic challenge. This challenge may, however, extend beyond paediatric anaesthesia because the implicated drugs are widely used in a variety of other settings in infants and young children around the world.