Neuraxial Analgesia for Caesarean and Vaginal Delivery and Childhood Learning Disabilities

  • J. Sprung
  • R. Flick
  • D. Warner
Conference paper


The short- and long-term effects of obstetric anaesthetic techniques on behaviour and development of the neonate, infant and child have been of long-standing interest. It is clear that these techniques may at least transiently affect some aspects of newborn behaviour [1, 2, 3, 4, 5, 6, 7]. However, the impact of obstetric analgesia and anaesthesia on long-term outcomes in the absence of concurrent events such as foetal asphyxia is not known. Studies evaluating the association between perinatal and environmental characteristics and childhood behavioural outcomes have suggested that operative or instrumented deliveries per se are not linked to childhood behavioural disorders or abnormalities in cognitive, verbal or reading functioning [8, 9, 10, 11, 12], but these studies do not specifically evaluate the impact of anaesthesia and analgesia.


Vaginal Delivery Caesarean Delivery Regional Anaesthesia Learn Disability Labour Analgesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Lester BM, Als H, Brazelton TB (1982) Regional obstetric anesthesia and newborn behavior: a reanalysis toward synergistic effects. Child Dev 53: 687–692PubMedCrossRefGoogle Scholar
  2. 2.
    Brackbill Y, Kane J, Manniello RL, Abramson D (1974) Obstetric meperidine usage and assessment of neonatal status. Anesthesiology 40: 116–120PubMedCrossRefGoogle Scholar
  3. 3.
    Kraemer HC, Korner A, Anders T et al (1985) Obstetric drugs and infant behavior: a reevaluation. J Pediatr Psychol 10: 345–353PubMedCrossRefGoogle Scholar
  4. 4.
    Scanlon JW, Brown WU Jr, Weiss JB, Alper MH (1974) Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology 40: 121–128PubMedCrossRefGoogle Scholar
  5. 5.
    Scanlon JW, Ostheimer GW, Lurie AO et al (1976) Neurobehavioral responses and drug concentrations in newborns after maternal epidural anesthesia with bupivacaine. Anesthesiology 45: 400–405PubMedCrossRefGoogle Scholar
  6. 6.
    Friedman SL, Brackbill Y, Caron AJ, Caron AF (1978) Obstetric medication and visual processing in 4- and 5-month-old infants. Merrill-Palmer Quarterly 24: 111–128Google Scholar
  7. 7.
    Kron RE, Stein M, Goddard KE (1966) Newborn sucking behavior affected by obstetric sedation. Pediatrics 37: 1012–1016PubMedGoogle Scholar
  8. 8.
    Broman SH, Nichols PL, Kennedy WA (1975) Preschool IQ: prenatal and early developmental correlates. L. Erlbaum, HillsdaleGoogle Scholar
  9. 9.
    McGee R, Silva PA, Williams S (1984) Perinatal, neurological, environmental and developmental characteristics of seven-year-old children with stable behaviour problems. J Child Psychol Psychiatry 25: 573–586PubMedCrossRefGoogle Scholar
  10. 10.
    Pasamanick B, Rogers ME, Lilienfeld AM (1956) Pregnancy experience and the development of behavior disorders in children. Am J Psychiatry 112: 613–618PubMedGoogle Scholar
  11. 11.
    McBride WG, Black BP, Brown CJ et al (1979) Method of delivery and developmental outcome at five years of age. Med J Aust 1: 301–304PubMedGoogle Scholar
  12. 12.
    Wesley BD, van den Berg BJ, Reece EA (1993) The effect of forceps delivery on cognitive development. Am J Obstet Gynecol 169: 1091–1095PubMedGoogle Scholar
  13. 13.
    Ikonomidou C, Bosch F, Miksa M et al (1999) Blockade of NMDA receptors and apoptotic neurodegeneration in the developing brain. Science 283: 70–74PubMedCrossRefGoogle Scholar
  14. 14.
    Olney JW, Wozniak DF, Jevtovic-Todorovic V et al (2002) Drug-induced apoptotic neurodegeneration in the developing brain. Brain Pathol 12: 488–498PubMedCrossRefGoogle Scholar
  15. 15.
    Jevtovic-Todorovic V, Benshoff N, Olney JW (2000) Ketamine potentiates cere- brocortical damage induced by the common anaesthetic agent nitrous oxide in adult rats. Br J Pharmacol 130: 1692–1698PubMedCrossRefGoogle Scholar
  16. 16.
    Olney JW, Young C, Wozniak DF et al (2004) Do pediatric drugs cause developing neurons to commit suicide? Trends Pharmacol Sci 25: 135–139PubMedCrossRefGoogle Scholar
  17. 17.
    Mellon RD, Simone AF, Rappaport BA (2007) Use of anesthetic agents in neonates and young children. Anesth Analg 104: 509–520PubMedCrossRefGoogle Scholar
  18. 18.
    Wang C, Sadovova N, Fu X et al (2005) The role of the N-methyl-D-aspartate receptor in ketamine-induced apoptosis in rat forebrain culture. Neuroscience 132: 967–977PubMedCrossRefGoogle Scholar
  19. 19.
    Rizzi S, Carter LB, Ori C, Jevtovic-Todorovic V (2008) Clinical anesthesia causes permanent damage to the fetal guinea pig brain. Brain Pathol 18: 198–210PubMedCrossRefGoogle Scholar
  20. 20.
    Jevtovic-Todorovic V, Hartman RE, Izumi Y et al (2003) Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci 23: 876–882PubMedGoogle Scholar
  21. 21.
    Wilder RT, Flick RP, Sprung J et al (2009) Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology 110: 796–804PubMedCrossRefGoogle Scholar
  22. 22.
    Rice D, Barone S Jr (2000) Critical periods of vulnerability for the developing nervous system: evidence from humans and animal models. Environ Health Perspect 108 (3): 511–533PubMedCrossRefGoogle Scholar
  23. 23.
    Rosenblatt DB, Belsey EM, Lieberman BA et al (1981) The influence of maternal analgesia on neonatal behaviour: II. Epidural bupivacaine. Br J Obstet Gynaecol 88: 407–413PubMedCrossRefGoogle Scholar
  24. 24.
    Hodgkinson R, Bhatt M, Grewal G, Marx GF (1978) Neonatal neurobehavior in the first 48 hours of life: effect of the administration of meperidine with and without naloxone in the mother. Pediatrics 62: 294–298PubMedGoogle Scholar
  25. 25.
    Lieberman BA, Rosenblatt DB, Belsey E et al (1979) The effects of maternally administered pethidine or epidural bupivacaine on the fetus and newborn. Br J Obstet Gynaecol 86: 598–606PubMedCrossRefGoogle Scholar
  26. 26.
    Golub MS, Germann SL (1998) Perinatal bupivacaine and infant behavior in rhesus monkeys. Neurotoxicol Teratol 20: 29–41PubMedCrossRefGoogle Scholar
  27. 27.
    Charmandari E, Kino T, Souvatzoglou E, Chrousos GP (2003) Pediatric stress: hormonal mediators and human development. Horm Res 59: 161–179PubMedCrossRefGoogle Scholar
  28. 28.
    Hayashi A, Nagaoka M, Yamada K et al (1998) Maternal stress induces synaptic loss and developmental disabilities of offspring. Int J Dev Neurosci 16: 209–216PubMedCrossRefGoogle Scholar
  29. 29.
    King S, Laplante DP (2005) The effects of prenatal maternal stress on children’s cognitive development: Project Ice Storm. Stress 8: 35–45PubMedCrossRefGoogle Scholar
  30. 30.
    Vogl SE, Worda C, Egarter C et al (2006) Mode of delivery is associated with maternal and fetal endocrine stress response. BJOG 113: 441–445PubMedCrossRefGoogle Scholar
  31. 31.
    Kapoor A, Matthews SG (2005) Short periods of prenatal stress affect growth, behaviour and hypothalamo-pituitary-adrenal axis activity in male guinea pig offspring. J Physiol 566: 967–977PubMedCrossRefGoogle Scholar
  32. 32.
    Schneider ML, Roughton EC, Koehler AJ, Lubach GR (1999) Growth and development following prenatal stress exposure in primates: an examination of ontogenetic vulnerability. Child Dev 70: 263–274PubMedCrossRefGoogle Scholar
  33. 33.
    O’Connor TG, Heron J, Golding J et al (2002) Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry 180: 502–508PubMedCrossRefGoogle Scholar
  34. 34.
    Griffin WC 3rd, Skinner HD, Salm AK, Birkle DL (2003) Mild prenatal stress in rats is associated with enhanced conditioned fear. Physiol Behav 79: 209–215PubMedCrossRefGoogle Scholar
  35. 35.
    Zappitelli M, Pinto T, Grizenko N (2001) Pre-, peri-, and postnatal trauma in subjects with attention-deficit hyperactivity disorder. Can J Psychiatry 46: 542–548PubMedGoogle Scholar
  36. 36.
    Taylor A, Fisk NM, Glover V (2000) Mode of delivery and subsequent stress response ( Research Letter ). Lancet 355: 120PubMedCrossRefGoogle Scholar
  37. 37.
    Loughran PG, Moore J, Dundee JW (1986) Maternal stress response associated with caesarean delivery under general and epidural anaesthesia. Br J Obstet Gynaecol 93: 943–949PubMedCrossRefGoogle Scholar
  38. 38.
    Flick, RP, Lee K, et al (2010) Neuraxial labor analgesia for vaginal delivery and childhood learning disabilities. Anesthesia and Analgesia doi: 10.1213/ ANE.0b013e3181f2ecddGoogle Scholar
  39. 39.
    Abboud TK, Sarkis F, Hung TT et al (1983) Effects of epidural anesthesia during labor on maternal plasma beta-endorphin levels. Anesthesiology 59: 1–5PubMedCrossRefGoogle Scholar
  40. 40.
    Miller NM, Fisk NM, Modi N, Glover V (2005) Stress responses at birth: determinants of cord arterial cortisol and links with cortisol response in infancy. BJOG 112: 921–926PubMedCrossRefGoogle Scholar
  41. 41.
    Kramer MS, Lydon J, Seguin L et al (2009) Stress pathways to spontaneous pre-term birth: the role of stressors, psychological distress, and stress hormones. Am J Epidemiol 169: 1319–1326PubMedCrossRefGoogle Scholar
  42. 42.
    Gitau R, Menson E, Pickles V et al (2001) Umbilical cortisol levels as an indicator of the fetal stress response to assisted vaginal delivery. Eur J Obstet Gynecol Reprod Biol 98: 14–17PubMedCrossRefGoogle Scholar
  43. 43.
    Sprung J, Flick RP, Wilder RT et al (2009) Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort. Anesthesiology 111: 302–310PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • J. Sprung
  • R. Flick
  • D. Warner

There are no affiliations available

Personalised recommendations