Surgical anesthesia in young children linked to effects on IQ

Children who received general anesthesia for surgery before age 4 had diminished language comprehension, lower IQ and decreased gray matter density in posterior regions of their brain, according to a new study in the journal Pediatrics.

Researchers from Cincinnati Children’s Hospital Medical Center report their findings in the journal’s June 8 online edition. The authors recommend additional studies to determine anesthesia’s precise molecular effects on the brain and contribution to diminished brain function and composition. Researchers say this knowledge could make it possible to develop mitigating strategies for what the authors describe as a potential dilemma for child health.

“The ultimate goal of our laboratory and clinical research is to improve safety and outcomes in young children who have no choice but to undergo surgery with anesthesia to treat their serious health concerns,” said Andreas Loepke, MD, PhD, FAAP, lead study author and an anesthesiologist in the Department of Anesthesiology at Cincinnati Children’s. “We also have to better understand to what extent anesthetics and other factors contribute to learning abnormalities in children before making drastic changes to our current practice, which by all measures has become very safe.”

Loepke and his research colleagues have published previous studies showing widespread cell death, permanent deletion of neurons and neurocognitive impairment in laboratory rats and mice after exposure to general anesthesia. Those studies have raised concerns about similar effects in young children during a particularly sensitive neurodevelopmental period in early life, which researchers say could interfere with the refinement of neuronal networks and lead to long-term functional abnormalities.

For their current retrospective study, the authors compared the scores of 53 healthy participants of a language development study (ages 5 to 18 years with no history of surgery) with the scores of 53 children in the same age range who had undergone surgery before the age of 4.

The authors stress that average test scores for all 106 children in the study were within population norms, regardless of surgical history. Still, compared with children who had not undergone surgery, children exposed to anesthesia scored significantly lower in listening comprehension and performance IQ. Researchers also report that decreased language and IQ scores were associated with lower gray matter density in the occipital cortex and cerebellum of the brain.

Researchers, who used extensive analysis of surgical and other medical records, said the children were matched for age, gender, handedness and socioeconomic status — all confounding factors of cognition and brain structure. The authors also factored into their calculations the types of surgeries and length of exposure to anesthetics. The anesthetics used during the surgeries included common agents such as sevoflurane, isoflurane or halothane (used alone or in combination) and nitrous oxide.

Children included in the study did not have a history of neurologic or psychological illness, head trauma or any other associated conditions. Neurocognitive assessments included the Oral and Written Language Scales and the Wechsler Intelligence Scale. Brain structural comparisons were conducted by MRI scans.

Cervical malignancy ‘not only a young lady’s illness’

There is a recognition that cervical malignancy is a young lady’s illness, yet a large portion of passings happen in ladies more than 65, a British Medical Journal report says.

It contends that as far as possible for cervical screening ought to be raised to 70 and more established ladies ought to be focused in wellbeing battles.

There was a normal of 449 passings from the disease in more than 65s and seven in less than 25s somewhere around 2010 and 2012.The report says the quantity of more established ladies influenced is situated to increment.

By the age of 60-64, just 72% of women in England in 2013 had been screened in the previous five years.

This compares with 82% of 50 to 54-year-olds and 76% of 55 to 59-year-olds.

While cervical cancer is the most common cancer in women under 35, it continues to affect women of all ages.

Endometriosis ‘risks miscarriage’

Women with endometriosis are more likely to lose the baby and need extra care, say fertility doctors.  It is caused by the lining of the uterus being found elsewhere in the body including the ovaries or vagina.  A study, on nearly 15,000 people in Scotland, found the condition increased the risk of miscarriage by 76%. The team at Aberdeen Royal Infirmary said that women needed to be informed of the risk. Endometriosis can be hard to identify and is thought to affect between 2% and 10% of women.Symptoms include painful periods and stomach pain.

The research team analysed data from 5,375 women with endometriosis and 8,280 healthy women.

Data to be presented at the annual meeting of the European Society of Human Reproduction and Embryology will show most pregnancies were fine, but there was a higher rate of complications.

The odds of an ectopic pregnancy – in which the foetus develops outside the womb – were nearly trebled from 0.6% normally to 1.6% with endometriosis.

The chance of miscarriage increased by 76%, a premature birth by 26% and the need for a caesarean section by 40%.

It is thought changes to the way the uterus functions as well as increased inflammation were damaging the pregnancy.

Dr Lucky Saraswat, who will present the findings at the meeting in Lisbon, said: “Some things cannot be changed like ectopic pregnancy or miscarriage.

“[If] we can diagnose it sooner so we can act sooner… with early intervention and probably improve outcomes for these women.”

She said such women may need extra monitoring, such as more ultrasound scans, during the pregnancy.

Prof Andrew Horne, a consultant gynaecologist at the MRC Centre for Reproductive Health at the University of Edinburgh, said most women with endometriosis would become pregnant naturally.

“However, we do not discuss what happens when they do become pregnant.

“These new findings suggest that we may need to warn women with endometriosis who become pregnant that they are at higher risk of both early and late complications in pregnancy, and may warrant increased antenatal monitoring.”

British Fertility Society chairman Prof Adam Balen said endometriosis was a lifelong condition and could be difficult to treat.

“You can treat it surgically, but it often recurs, you can try to suppress it with hormones, but the hormones are contraceptive at the same time

“If a woman wants to get pregnant and it’s fairly mild you may try and treat it surgically and allow her to conceive naturally. Or they may end up needing IVF in which case you use hormone suppression.”

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