Tuesday, March 24, 2009

Anesthesia Exposure=Kid's Learning Disabilities

Mayo Researchers Find Link Between Anesthesia Exposure and Learning Disabilities in Children

Mayo Clinic researchers have found that children who require multiple surgeries under anesthesia during their first three years of life are at higher risk of developing learning disabilities later. Several studies have suggested that anesthetic drugs may cause abnormalities in the brains of young animals. This is the first study in humans to suggest that exposure of children to anesthesia may have similar consequences. The finding is reported in the current issue of the journal Anesthesiology http://journals.lww.com/anesthesiology/pages/default.aspx).

Using data from the long-term Rochester Epidemiology Project (http://mayoresearch.mayo.edu/mayo/research/rep/), researchers studied the medical records of 5,357 children from Olmsted County who were born between 1976 and 1982.

The research team, led by Robert Wilder, M.D., Ph.D., a Mayo Clinic anesthesiologist, found that although one exposure to anesthesia was not harmful, more than one almost doubled the risk that a child would be identified as having a learning disability before age 19. The risk also increased with longer durations of anesthesia.

"It's very important for parents and families to understand that although we see a clear difference in the frequency of learning disabilities in children exposed to anesthesia, we don't know whether these differences are actually caused by anesthesia," says Randall Flick, M.D., a Mayo Clinic anesthesiologist and co-author of the study.

"The problem is that anyone who underwent an anesthetic also had surgery," says Dr. Wilder. "It's unclear whether it's the anesthetic, the physiological stress of surgery or perhaps the medical problems that made surgery necessary that are responsible for the learning disabilities."

Young children's brains are more vulnerable to a variety of problems because they are undergoing dynamic growth. The brain is rapidly forming connections between cells and trimming excess cells and connections, says Dr. Wilder.

The general anesthesia chemicals in use during the study period were primarily halothane and nitrous oxide (laughing gas). Although halothane is no longer used in the U.S., it has been replaced by newer agents that have similar effects on the brain. Nitrous oxide is widely used throughout the U.S. and the world.

Debate exists about the developmental correlation between the animal (rodent) and human studies. Some think that the related exposure period would be perinatal in humans (the last month of pregnancy and first six months after birth), so the researchers repeated their analysis, examining anesthetic exposure before age 2, and found similar results.

"Parents and physicians need to balance this information along with the normal decisions that we all go through when we decide to have surgery for one of our children," says Dr. Flick. "Although alternatives to the use of these medications exist, they are limited. Certainly, performing surgery without appropriate use of anesthesia is unacceptable."

The children in the study were tested as a natural part of the educational process in the Rochester school system. They did not perform as well in reading, writing or math as their IQ tests indicated.

Other studies have linked anesthesia exposure in young children to behavioral problems. Dr. Flick says the Food and Drug Administration (FDA) is aware of the possible problems with anesthesia. "They've been very proactive in trying to gather information as quickly and thoughtfully as possible," Dr. Flick says, "but much more research is needed before we could conclude that anesthesia itself causes problems." He also encourages families with questions to go to the Web sites of the American Society of Anesthesiology and the Society for Pediatric Anesthesia.

The research team is working to obtain funding to extend the database for 10 more years (1982-1992), a period that would include the use of more modern anesthetics. They are also working with the FDA to complete a study that matches children who had an anesthetic with children who have a similar medical problem but did not receive an anesthetic.

Monday, March 2, 2009

Classifying concussions could help kids

It's estimated that more than a half million kids in the U.S. go to the hospital each year with a concussion.* That's an average of a kid per minute- every minute of every day. Some concussions are worse than others but it might surprise you to know that almost all of them are treated the same. New research is pointing toward a more sophisticated way of diagnosing and treating concussions in kids.

13 year old Dustin Edens had to work on his game by himself for a few days, after a recent run-in with a teammate during basketball practice.

"He drove right around the pick and came at me and hit me with his shoulder first, right into my chest, and my head bounced off the ground," says Dustin.

It was Dustin's third concussion in two months, although it might surprise you to know that it's often hard for doctors to tell where one concussion ends and another begins.

"We don't have tests that tell us when someone has recovered from their concussion," says Karl Klamar, MD at Nationwide Children's Hospital.

Instead doctors have to rely mostly on patients to tell them when they feel better. Things like headaches, fatigue, and irritability can all be signs that the concussion is lingering, and in some cases they can linger a long time.

"There is this group of kids that are at risk and do seem to be able to continue to have these symptoms even up to a year after their injury," says Keith Yeates, PhD at Nationwide Children's Hospital.

To better understand which kids may be at risk Doctor Yeates, of Nationwide Children's Hospital followed nearly 200 children with concussions for a year. His study, published in Pediatrics, found that while most kids had few problems, one out of every four experiences significant post concussive symptoms, some of which never fully resolved. And those whose concussions resulted in a loss of consciousness, amnesia or an abnormal CT scan were more likely to have symptoms that persist.

"We do know that there are kids at risk, and we can begin to identify them, monitor them over time and provide appropriate intervention and assistance if they have these symptoms," says Dr. Yeates.

Doctor Yeates believes classifying concussions as high risk or low risk may help physicians determine which patients need special attention, which could give them a better "shot" at a faster recovery. So how do you know if your child has suffered a concussion? For tips and symptoms you should watch for, log on it www.NationwideChildrens.org, keyword "concussion."

*Longitudinal Trajectories of Postconcussive Symptoms in Children With Mild Traumatic Brain Injuries and Their Relationship to Acute Clinical Status, Pediatrics, Volume 123, Number 3, March, 2009.

Kids like vegetables w/catchy new names

Names turn preschoolers into vegetable lovers

Do you have a picky preschooler who's avoiding their vegetables? A new Cornell University study shows that giving vegetables catchy new names – like X-Ray Vision Carrots and Tomato Bursts – left preschoolers asking for more.

When 186 four-year olds were given carrots called "X-ray Vision Carrots" ate nearly twice as much as they did on the lunch days when they were simply labeled as "carrots." The Robert Wood Johnson-funded study also showed the influence of these names might persist. Children continued to eat about 50% more carrots even on the days when they were no longer labeled. The new findings were presented on Monday at the annual meeting of the School Nutrition Association in Washington DC.

"Cool names can make for cool foods," says lead author Brian Wansink. "Whether it be 'power peas' or 'dinosaur broccoli trees,' giving a food a fun name makes kids think it will be more fun to eat. And it seems to keep working – even the next day," said Wansink.

Similar results have been found with adults. A restaurant study showed that when the Seafood Filet was changed to "Succulent Italian Seafood Filet," sales increased by 28% and taste rating increased by 12%. "Same food, but different expectations, and a different experience," said Wansink, author of "Mindless Eating: Why We Eat More Than We Eat More Than We Think."

Although the study was conducted in pre-schools, the researchers believe the same naming tricks can work with children. "I've been using this with my kids," said researcher Collin Payne, "Whatever sparks their imagination seems to spark their appetite."