Anesthesia, extremely premature infants and full-scale intelligence quotient at 5 years of age.

BACKGROUND

To determine the association between exposure to Food and Drug Administration (FDA) warned anesthetics in premature infants and their full-scale intelligence quotient (FSIQ) score at 5 years of age.

METHODS

Premature infants born <27 weeks gestational age (GA) between January 2006 and December 2012 with FDA anesthetic exposure status were included. Exposures included volatile anesthetics, propofol, benzodiazepines, ketamine, chloral hydrate, and barbiturates/phenobarbital. Exposure was treated as a binary variable with infants stratified into those who were or were not exposed to any FDA warned drug. Associations were explored using univariable and multivariable regressions.

RESULTS

238 (61.5%) of 387 eligible infants had available FSIQ scores. Of these, 110 (46.2%) were exposed to warned anesthetics. Unadjusted and adjusted imputed case associations (95% CI) between FDA warned anesthetics and FSIQ were -5 (-10 to -2, p = 0.014) and -2 (-7 to 3, p = 0.528) points. An unobserved confounder(s) the strength of severe IVH [-9 points (-15 to -3)] would be required to overturn the directional association between FDA exposure and FSIQ in our complete case model.

CONCLUSION

Premature infants exposed to anesthetics flagged by the FDA showed no significant reduction in FSIQ at 5 years of age.

IMPACT: It is unclear whether early exposure to anesthetics in premature infants born <27 weeks gestation is associated with full-scale intelligence quotient (FSIQ) at 5 years of age. Our retrospective cohort study included 387 premature infants born <27 weeks gestational age. FSIQ scores were available for 238/387 at 5 years of age of which 110 were exposed to Food and Drug Administration (FDA) warned anesthetic drugs. After missing data imputation and adjustment for maternal and neonatal characteristics, no significant associations were found between FDA warned anesthetic exposure and FSIQ. No adjusted volatile anesthetic or opioid dosage effect was associated with FSIQ.