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Systematic review of the neurocognitive outcomes used in studies of paediatric anaesthesia neurotoxicity
Authors:
Clausen, N. G., Kahler, S., and Hansen, T. G.
Abstract:
BACKGROUND: Neurotoxicity of anaesthetics in developing brain cells is well documented in preclinical studies, yet results are conflicting in humans. The use of many and different outcome measures in human studies may contribute to this disagreement. METHODS: We conducted a systematic review to identify all measures used to assess long-term neurocognitive outcomes following general anaesthesia (GA) and surgery in children. The quality of studies was assessed according to the Newcastle-Ottawa Scale (NOS) for observational studies. PubMed/MEDLINE, EMBASE, Cinahl, Web of Science, and the Cochrane Library were searched for studies investigating neurocognitive outcome after GA in children <18 yr. RESULTS: Sixty-seven studies were identified from 19 countries during 1990-2017. Most assessments were performed within cognition, sensory-motor development, academic achievement or neuropsychological diagnosis. Few studies assessed other outcomes (magnetic resonance imaging, serum-biomarkers, mortality, neurological examination, measurement of head circumference, impairment of vision). Rating according to the NOS rewarded a mean of six stars out of nine. Some concerns prevail regarding potential inter-rater variability because of equivocal description of rating criteria. Specific features such as stability over lifetime and inter-relations of outcomes (e.g. prediction of subsequent development or diagnosis of neuropsychological conditions) are discussed. The importance of validity and reliability of the various test instruments are described. The studies vary immensely in important characteristics. CONCLUSIONS: Future observational studies should be more consistent in the choice of study population, age at exposure, follow-up, indication for and type of surgery, and outcomes. Assessment of sensory-motor development seems feasible in young children (age <4 yr), and intelligence/cognition in older children.
DOI:
10.1016/j.bja.2017.11.107
URL:
https://pdf.sciencedirectassets.com/318044/1-s2.0-S0007091218X00075/1-s2.0-S0007091217542142/main.pdf?X-Amz-Security-Token=AgoJb3JpZ2luX2VjEKT%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJHMEUCIHdBbyXGeiQNu1gQdSv81Mxah9jPyfAr4HcLlve9eiS1AiEAjzAD%2BCIWGn1RTWxzZwrYxp2UQOFzZWCea6ucfT56%2BLsqhQQIrf%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARACGgwwNTkwMDM1NDY4NjUiDGNVQO1ykgRCEdhypSrZA%2FIIaD6Vcjj9KaFN7ALlXagOYmUfR8eoI0TLVGPvbct1Ku7E0UrziqqmUhd0dZgfpn0UESiGXwx%2FDoUh8PuTd3B0gwLs%2FoS%2BaiqzYzuy0oDJUF2eBRHLhpArzl2PaKhjPFgD9rzvGx8s%2BzKjuje3gzIBJ1et0e0deSl9UFx1pNwdw2rtImbopLPzMzF5cn5ZfabuieedDCmWgmS2vaB1XhUNexBbASIT3ofWOGxZ%2F%2FexDrDxIln5%2FWiOUB5oWYsa8J%2FSNA%2Fx6Y0ec%2B5pbT9qWCXqnSLvb6WDm55hMhDNsziN0qRbtBKt0Xz4XUiVD%2B8Mhz4M34A%2F6aqitTPnYG2v%2BIwEW66taOeJWGoVvkmMeO7plzvBB2%2BDamX5rJYsdERr0la9kFV2Yyw0ByvV7X0GpoKIe2LqIbJvPVNG9bcC3k0U5DqNYdhVx3XWDaU%2Ba7u0TMI5PEJlBqsjTfzQbg0fkVsP92s3xwLJWLxc8LW6gMezT10H%2FfzYceMB4EpVk8OS4YJ%2Bdq8AW4k5g9AvqactIZjRUU4ApqnLNUkizP%2BC5XrDKYDpnD0nCeI7prVVc9Hqkwomw7rbh%2FW6%2Bm7VwvDAj%2FLYdSoVEPzIKhkXMcMZYZrwfYmYhzhApDVZMKK14u0FOrQB1KNSATN2S86460lVW2Xcm5H1vSH0aiqru9aVZjLhtblIionlRqTkl3hjuFHfyiu5Q3PJKJEY7%2BplJAUq1C3odIRSMSRJGycsBQ6rCqEaXdGCCAffKjZIlysJvWHqWW9ClEl5m7bsdtquklkZ7b2d99rzGaCNjC5vv2aVsyFC6c9WpdvpRelgQUXUpQEqS5o2iAEa%2B2oXQx10A37ZFFavTQw0WOzjJM1K93hMIJ80BgvoHWHY&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20191029T202534Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTYYJT5QOG3%2F20191029%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=8ec1f2a0d910c1ac453eff3c1d5441c7af9069543d5975dc13b4903996277e5e&hash=c0ebdbda191204c24eb24a0a7f7226b30355bd3471b739cd51104bde7af683a7&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S0007091217542142&tid=spdf-352fb1ca-7edd-4d37-ac1b-d8f4920c1e50&sid=c2e3d7829a2ab54ff38a5e53f963b2c46d73gxrqb&type=client
Journal:
Br J Anaesth
issn:
0007-0912
Publication year:
2018
pages:
1255-1273
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Cognitive/mental state
Functional status:
Cognitive/mental functioning
Age:
Children (0-18)
Disease:
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
Instrument:
ABAS - Adaptive Behavior Assessment System (versions: ABAS-II - ABAS-2nd Edition) AIMS - Alberta Infant Motor Scale ASQ - Ages and Stages Questionnaire (versions: ASQ-3) BRIEF - Behaviour Rating Inventory of Executive Function (versions: BRIEF-Adult; BRIEF-C; BRIEF-SR; BRIEF-2; BRIEF-parent; BRIEF-teachers; BRIEF-personal; BRIEF-preschool) BSID-II - Bayley Scales of Infant Development II BSID-III - Bayley Scales of Infant Development-III [alias: Bayley-III] CAT - California Achievement Test CBCL - Child Behavior Checklist (versions: CBCL-2; CBCL-3; CBCL-ADHD; CBCL-teacher rated; CBCL-Y - CBCL Youth; CBCL/6-18) CDI - Children's Depression Inventory (versions: SCDI; CDI-SF) CELF - Clinical Evaluation of Language Fundamentals (versions: CELF-3; CELF-4; CELF-5; CELF-Total; CELF-Expressive; CELF-Receptive; CELF-Preschool2) CHQ - Child Health Questionnaire (versions: CHQ-SF; CHQ50) Conners Parent Teacher Rating Scale-revised CPM - Raven’s Colored Progressive Matrices CPT - Continuous Performance Test Original (versions: CPT-II; VRCPT) CVLT - California Verbal Learning Test (versions: CVLT-C; CVLT-II edition; CVLT-I - Intrusions) D-KEFS - Delis-Kaplan Executive Function System (versions: D-KEFS - Design Fluency Test) DSM-ADH - Diagnostic and Statistical Manual of Mental Disorders-attention deficit hyperactivity scores DSM - Diagnostic and Statistical Manual of Mental Disorders (versions: DSM-IV -4th Edition; DSM-5 - DSM 5th edition) DS test - Digit Span test (versions: Visual aural DS test; FDS - Forward DS test; BDS - Backward DS) EDI - Early Development Instrument FSIQ - Full scale intelligence-quotient FT - Fluency Tests (versions: CFT - Category FT; Ruff figural FT; Phonemic verbal FT; Semantic verbal FT; Category FT) GDQ - General Developmental Quotient GDS - Gesell Developmental Schedule GMDS - Griffiths Mental Developmental Scales GMFCS - General Motor Function Classification Score Grooved Pegboard Test G-TVPS - Gardner Test of Visual-Perceptual Skills Revised HAWIVA-III - HannovereWechsler Intelligence Scale, 3rd Edition ICD-9-CM 299.00 - International Classification of Disease-9th Autistic Disorder Diagnoses ICD-9-CM 314.01 - International Classification of Diseases 9th-Attention Deficit Hyperactivity Disorder ICD-9 - International classification of Disease-9th Edition IEP-EBD - Individualised Educational Program-Disorders of Emotion and Behaviour IEP-SL - Individualised Educational Program-Speech and Language K-ABC - Kaufman Assessment Battery for Children (CHC module) KET-KID - Kognitiver Enwicklungstest füf das Kindergartenalter LD - Learning Disability MacArthur-Bates CDI - McArthur Bates Communicative Development Inventory MAND - McCarron Assessment of Neuromuscular Development MRI - Magnetic Resonance Imaging (versions: 2D MRI; 3D MRI; pMRI; sMRI; vMRI; rsMRI) NEPSY - Developmental NEuroPSYchological Assessment (versions: NEPSY-social cognotion; NEPSY-II) Neurological examination OLSAT - Otis Lennon School Ability test OWLS - Oral and Written Language Scales PDMS - Peabody Developmental Motor Scales PIQ - Performance Intelligence-Quotient PPVT - Peabody Picture Vocabulary Test-Revised (versions: PPVT-4) PSLE - Primary School Leaving Examination RAVLT - Rey Auditory Verbal Learning Test RDLS (I-IV) - Reynell Developmental Language Scales (!-IV) SB-5 - Stanford-Binet Intelligence Scales-5th Edition SCWT - Stroop Color-Word Test SDMT - Symbol Digit Modalities Test (alias: SDMT-written version; sSDMT - Smartphone-adapted SDMT) Serum biomarkers of Brain derived neurotrophic factor (BDNF), S100B SON-R - Hogrefe/Snijders-Oomen Non-Verbal Intelligence Test-Revised Surrogate measures of visual function TCS - Total Cognitive Skills TEA-Ch NL - Test of Everyday Attention for Children (versions: TEA-Ch NL - Dutch version; TEA-Ch-Sky Search) TIQ - Total Intelligence Quotient TMT - Trail Making Test (versions: ETMT - Expanded TMT; TMT-B) VABS - Vineland Adaptive Behavior Scales (versions: VABS-I; VABS-II; VABS-Classroom ed) VIQ - Verbal Intelligence-Quotient VMI - Beery Buktenica Developmental Test of Visual Motor Integration, 5th Edition Wallin BP - Wallin B pegboard WAMSE - Western Australian Monitoring Standards in Education WASI - Wechsler Abbreviated Scale of Intelligence WeeFIM - Functional Independence Measure for Children [alias: PFIM - Pediatric Functional Independence Measure] WISC - Wechsler Intelligence Scale for Children (versions: WISC-III; WISC-IV; WISC-V; WISC-R) WJ III - Woodcock Johnson Achievement III (versions: WJ III Visual Matching) WPPSI - Wechsler Preschool and Primary Scale of Intelligence (versions: WPPSI-R; WPPSI-III; WPPSI-IV)
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