. 2013 Mar 29;110(Suppl 1):i53–i72. doi: 10.1093/bja/aet054

Table 3.

Clinical observational studies of neurocognitive impairment after infant anaesthesia and surgery (IAS). NOS, Newcastle–Ottawa Score

Reference	Design	Study period	Follow-up	Sample size	Operations	Anaesthetic	Confounder adjustment	Outcomes with exposure to anaesthesia and surgery	Grade of evidence	NOS (max=9*)
DiMaggio and colleagues¹⁹	Birth case–control	1991–2001	1–2 yr	5050 control, 383 exposed	Inguinal hernia repair	N/A	Yes	Behavioural/developmental delay after IAS	B	8*
Hansen and colleagues¹⁷	Birth cohort	1986–1990	25–16 yr	14 575 control, 2689 exposed	Inguinal hernia repair	N/A	Yes	Academic performance: No difference but increased non-attainment of test scores with IAS	B	8*
Ing and colleagues²¹	Birth cohort	1989–1992	10 yr	2287 control, 321 exposed	Varied	N/A	Yes	Neuropsychological testing: increased expressive and receptive language deficits after IAS	B	8*
Wilder and colleagues²⁴	Birth cohort	1976–1982	19 yr	4764 control, 593 exposed	Varied	Known	Yes	Increased learning difficulties with increased exposure to IAS	B	8*
Sprung and colleagues²³	Birth cohort	1976–1982	19 yr	5357 control, 531 exposed	Varied	Known	Yes	Increased ADHD with increased exposure to IAS	B	8*
Flick and colleagues²²	Case–control	1976–1982	19 yr	5007 controls, 350 exposed	Varied	Known	Yes	Increased learning difficulties after IAS	B	8*
DiMaggio and colleagues²⁰	Sibling cohort	1999–2005		10146 control, 304 exposed	Varied	N/A	No	Increased developmental and behavioral disorders after IAS. Effect not found in more tightly controlled analysis	B	8*
Block and colleagues²⁵	Treatment cohort	1990–2008	7–17.9 yr	287 exposed	Inguinal hernia, orchidopexy, pyloromyotomy	Known	No	Academic achievement tests: mean scores lower than population norm after IAS	B	5*
Bartels and colleagues²⁶	MCMA twin cohort	1986–1995	12 yr	1890 control, 1248 exposed	Varied	N/A	Yes	Educational achievement: scores significantly lower than population norm for males, non-significantly lower for females after IAS. However, no effect observed between monozygotic twins	B	8*