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. 2017 Jul;29(3):264-273.
doi: 10.1097/ANA.0000000000000303.

Latent Class Analysis of Neurodevelopmental Deficit After Exposure to Anesthesia in Early Childhood

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Latent Class Analysis of Neurodevelopmental Deficit After Exposure to Anesthesia in Early Childhood

Caleb Ing et al. J Neurosurg Anesthesiol. .
Free PMC article

Abstract

Introduction: Although some studies have reported an association between early exposure to anesthesia and surgery and long-term neurodevelopmental deficit, the clinical phenotype of children exposed to anesthesia is still unknown.

Methods: Data were obtained from the Western Australian Pregnancy Cohort Study (Raine) with neuropsychological tests at age 10 years measuring language, cognition, motor function, and behavior. Latent class analysis of the tests was used to divide the cohort into mutually exclusive subclasses of neurodevelopmental deficit. Multivariable polytomous logistic regression was used to evaluate the association between exposure to surgery and anesthesia and each latent class, adjusting for demographic and medical covariates.

Results: In our cohort of 1444 children, latent class analysis identified 4 subclasses: (1) Normal: few deficits (n=1135, 78.6%); (2) Language and Cognitive deficits: primarily language, cognitive, and motor deficits (n=96, 6.6%); (3) Behavioral deficits: primarily behavioral deficits, (n=151, 10.5%); and (4) Severe deficits: deficits in all neuropsychological domains (n=62, 4.3%). Language and cognitive deficit group children were more likely to have exposure before age 3 (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.17-3.81), whereas a difference in exposure was not found between Behavioral or Severe deficit children (aOR, 1.00; 95% CI, 0.58-1.73, and aOR, 0.85; 95% CI, 0.34-2.15, respectively) and Normal children.

Conclusions: Our results suggest that in evaluating children exposed to surgery and anesthesia at an early age, the phenotype of interest may be children with deficits primarily in language and cognition, and not children with broad neurodevelopmental delay or primarily behavioral deficits.

Figures

Appendix Figure 1
Appendix Figure 1
Proportion of Children within Each Latent Class with any ICD-9 Codes in Each Clinical Classification Software (CCS) Category
Appendix Figure 2
Appendix Figure 2
Proportion of Children within Each Latent Class with ICD-9 Codes Requiring a Hospital Visit in Each Clinical Classification Software (CCS) Category
Figure 1
Figure 1. Proportion of Children in Each of Four Latent Classes with Deficits in Specific Neuropsychological Assessments
Legend 1: CELF-R = Clinical Evaluation of Language Fundamentals (CELF) Receptive Language score; CELF-E = CELF Expressive Language score; CPM = Colored Progressive Matrices; SDMT-O = Symbol Digit Modality Test (SDMT) Oral score; SDMT-W = SDMT Written score; MAND = McCarron Assessment of Neuromuscular Development; CBCL-INT = Child Behavior Checklist (CBCL) Internalizing score; CBCL-EXT = CBCL Externalizing score; CBCL-T = CBCL Total score.

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