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Salaün JP, Borst G, Cachia A, Orliac F, Vivien D, Poirel N. Effects of general anaesthesia in early childhood on local and global visual processing: a post hoc analysis of the APEX cohort study. Br J Anaesth 2024; 133:344-350. [PMID: 38862383 DOI: 10.1016/j.bja.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/28/2024] [Accepted: 05/05/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Preclinical studies suggest that early exposure to anaesthesia alters the visual system in mice and non-human primates. We investigated whether exposure to general anaesthesia leads to visual attention processing changes in children, which could potentially impact essential life skills, including learning. METHODS This was a post hoc analysis of data from the APprentissages EXécutifs et cerveau chez les enfants d'âge scolaire (APEX) cohort study. A total of 24 healthy 9-10-yr-old children who were or were not exposed to general anaesthesia (for surgery) by a mean age of 3.8 (2.6) yr performed a visual attention task to evaluate ability to process either local details or general global visual information. Whether children were distracted by visual interference during global and local information processing was also assessed. RESULTS Participants included in the analyses (n=12 participants exposed to general anaesthesia and n=12 controls) successfully completed (>90% of correct answers) the trial tasks. Children from both groups were equally distracted by visual interference. However, children who had been exposed to general anaesthesia were more attracted to global visual information than were control children (P=0.03). CONCLUSIONS These findings suggest lasting effects of early-life exposure to general anaesthesia on visuospatial abilities. Further investigations of the mechanisms by which general anaesthesia could have delayed effects on how children perceive their visual environment are needed.
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Affiliation(s)
- Jean-Philippe Salaün
- Normandie Université, UNICAEN, Université Caen Normandie, INSERM, GIP CYCERON, Institut Blood and Brain @Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France; Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Caen Normandie, 14000 Caen, France.
| | - Grégoire Borst
- Université Paris Cité, LaPsyDÉ, CNRS, Paris, France; Institut Universitaire de France (IUF), Paris, France
| | - Arnaud Cachia
- Université Paris Cité, LaPsyDÉ, CNRS, Paris, France; Institut Universitaire de France (IUF), Paris, France
| | | | - Denis Vivien
- Normandie Université, UNICAEN, Université Caen Normandie, INSERM, GIP CYCERON, Institut Blood and Brain @Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France; Department of Clinical Research and Innovation, Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Nicolas Poirel
- Université Paris Cité, LaPsyDÉ, CNRS, Paris, France; Institut Universitaire de France (IUF), Paris, France; GIP CYCERON, Caen, France
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Gire C, Beltran Anzola A, Marret S, Foix L’Hélias L, Roze JC, Granier M, Patural H, Lecomte B, Guillois B, Souksi Medioni I, Bednarek Weirauch N, Claris O, Hascoët JM, Kuhn P, Zahed M, Boucekine M, Ancel PY, Arnaud C, Cambonie G, Dorriere Datin V. Cognitive Training for Visuospatial Processing in Children Aged 5½ to 6 Years Born Very Preterm With Working Memory Dysfunction: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2331988. [PMID: 37676661 PMCID: PMC10485729 DOI: 10.1001/jamanetworkopen.2023.31988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/20/2023] [Indexed: 09/08/2023] Open
Abstract
Importance Compared with term-born peers, children born very preterm generally perform poorly in executive functions, particularly in working memory and inhibition. By taking advantage of neuroplasticity, computerized cognitive training of working memory in those children could improve visuospatial processing by boosting visual inhibition via working memory. Objective To evaluate the long-term effect of cognitive working memory training on visuospatial processing in children aged 5½ to 6 years born very preterm who have working memory impairment. Design, Setting, and Participants This multicenter (18 French university hospitals), open-label randomized clinical trial with 2 parallel groups (EPIREMED) was conducted from November 2016 to April 2018, with the last follow-up during August 2019. Eligible children from the EPIPAGE 2 cohort were aged 5½ to 6 years, were born between 24 and 34 weeks' gestation, and had a global intelligence quotient greater than 70 and a working memory index less than 85. Data were analyzed from February to December 2020. Intervention Children were randomized 1:1 to standard care management and a working memory cognitive training program (Cogmed software) for 8 weeks (25 sessions) (intervention) or to standard management (control). Main Outcomes and Measures The primary outcome was the visuospatial index score from the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition. Secondary outcomes were working memory, intellectual functioning, executive and attention processes, language skills, behavior, quality of life, and schooling. Neurobehavioral assessments were performed at inclusion and after finishing training at 6 months (intermeditate assessment; secondary outcomes) and at 16 months (final assessment; primary outcome). Results There were 169 children randomized, with a mean (SD) age of 5 years 11 months (2 months); 91 (54%) were female. Of the participants, 84 were in the intervention group (57 of whom [68%] completed at least 15 cognitive training sessions) and 85 were in the control group. The posttraining visuospatial index score was not different between groups at a mean (SD) of 3.0 (1.8) months (difference, -0.6 points; 95% CI, -4.7 to 3.5 points) or 12.9 (2.6) months (difference, 0.1 points; 95% CI, -5.4 to 5.1 points). The working memory index score in the intervention group significantly improved from baseline at the intermediate time point (difference, 4.7 points; 95% CI, 1.2-8.1 points), but this improvement was not maintained at the final assessment. Conclusions and Relevance This randomized clinical trial found no lasting effect of a cognitive training program on visuospatial processing in children aged 5½ to 6 years with working memory disorders who were born very preterm. The findings suggest that this training has limited long-term benefits for improving executive function. Transient benefits seemed to be associated with the developmental state of executive functions. Trial Registration ClinicalTrials.gov Identifier: NCT02757794.
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Affiliation(s)
- Catherine Gire
- Department of Neonatology, North Hospital, Assistance Publique–Hôpitaux de Marseille University Hospital, Marseille, France
- Faculty of Medicine, Centre for Research on Health Services and Quality of Life–Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Any Beltran Anzola
- Department of Neonatology, North Hospital, Assistance Publique–Hôpitaux de Marseille University Hospital, Marseille, France
- Faculty of Medicine, Centre for Research on Health Services and Quality of Life–Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics & Intensive Care, University Hospital of Rouen, Rouen, France
| | - Laurence Foix L’Hélias
- Department of Neonatology, Armand Trousseau Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Jean-Christophe Roze
- Department of Neonatal & Pediatric Intensive Care, University Hospital of Nantes, Nantes, France
| | - Michèle Granier
- Department of Neonatology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Hugues Patural
- Department of Neonatal & Pediatric Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bénédicte Lecomte
- Department of Neonatal & Pediatric Intensive Care, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bernard Guillois
- Department of Neonatal & Intensive Care, University Hospital of Caen Normandie, Caen, France
| | | | | | - Olivier Claris
- Department of Neonatology & Neonatal Intensive Care, University Hospital of Lyon, Lyon, France
| | - Jean-Michel Hascoët
- Department of Neonatology, Regional University Hospital of Nancy, Nancy, France
| | - Pierre Kuhn
- Department of Neonatology, Regional University Hospital of Strasbourg, Strasbourg, France
| | - Meriem Zahed
- Department of Neonatology, North Hospital, Assistance Publique–Hôpitaux de Marseille University Hospital, Marseille, France
| | - Mohamed Boucekine
- Faculty of Medicine, Centre for Research on Health Services and Quality of Life–Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics, Paris University, INSERM, Paris, France
- Clinical Research Unit, Center for Clinical Investigation, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Catherine Arnaud
- Clinical Epidemiology Unit, University Hospital Toulouse, Toulouse, France
- Center for Epidemiology and Research in Population Health, University of Toulouse, INSERM, Paul Sabatier University, Toulouse, France
| | - Gilles Cambonie
- Department of Neonatal Pediatrics and Intensive Care, University Hospital of Montpellier, Montpellier, France
| | - Valérie Dorriere Datin
- Department of Neonatal & Intensive Care, University Hospital of Caen Normandie, Caen, France
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Gire C, Garbi A, Zahed M, Beltran Anzola A, Tosello B, Datin-Dorrière V. Neurobehavioral Phenotype and Dysexecutive Syndrome of Preterm Children: Comorbidity or Trigger? An Update. CHILDREN (BASEL, SWITZERLAND) 2022; 9:239. [PMID: 35204960 PMCID: PMC8870742 DOI: 10.3390/children9020239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/29/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Premature birth is a worldwide public health priority. One in ten children is born before 37 weeks of gestational age and, in developed countries, survival rates without major neonatal morbidity are increasing. Although severe sequelae associated with these births have decreased, their neurobehavioral difficulties, often associated in multiple fields, remain stable but still widespread. These neurobehavioral difficulties hamper the normal development of academic achievements and societal integration and intensify the children's needs for rehabilitation during their preschool and academic years. Severe sequelae increase when gestational age decreases. This is even truer if the socio-cultural background is impeded by low income, education and language skills as compared with defined averages. However, moderate and/or minor neurocognitive and/or behavioral difficulties are almost identical for a moderate or a late preterm birth. Obtaining a better clinical description of neurobehavioral characteristics of those pretermly born, once they reach preschool age, is essential to detect behavioral issues as well as early specific cognitive difficulties (working memory, planning, inhibition, language expression and reception, attention and fine motor skills, etc.). Such information would provide a better understanding of the executive functions' role in brain connectivity, neurodevelopment and neuroanatomical correlation with premature encephalopathy.
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Affiliation(s)
- Catherine Gire
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Aurélie Garbi
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
| | - Meriem Zahed
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
| | - Any Beltran Anzola
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Barthélémy Tosello
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CNRS, EFS, ADES, Aix Marseille Universite, 13915 Marseille, France
| | - Valérie Datin-Dorrière
- Department of Neonatal Medicine, Caen University Hospital, Avenue Cote De Nacre, 14000 Caen, France;
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Individual Attention Patterns in Children Born Very Preterm and Full Term at 7 and 13 Years of Age. J Int Neuropsychol Soc 2021; 27:970-980. [PMID: 33478617 DOI: 10.1017/s1355617720001411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify attention profiles at 7 and 13 years, and transitions in attention profiles over time in children born very preterm (VP; <30 weeks' gestation) and full term (FT), and examine predictors of attention profiles and transitions. METHODS Participants were 167 VP and 60 FT children, evaluated on profiles across five attention domains (selective, shifting and divided attention, processing speed, and behavioral attention) at 7 and 13 years using latent profile analyses. Transitions in profiles were assessed with contingency tables. For VP children, biological and social risk factors were tested as predictors with a multinomial logistic regression. RESULTS At 7 and 13 years, three distinct profiles of attentional functioning were identified. VP children were 2-3 times more likely to show poorer attention profiles compared with FT children. Transition patterns between 7 and 13 years were stable average, stable low, improving, and declining attention. VP children were two times less likely to have a stable average attention pattern and three times more likely to have stable low or improving attention patterns compared with FT children. Groups did not differ in declining attention patterns. For VP children, brain abnormalities on neonatal MRI and greater social risk at 7 years predicted stable low or changing attention patterns over time. CONCLUSIONS VP children show greater variability in attention profiles and transition patterns than FT children, with almost half of the VP children showing adverse attention patterns over time. Early brain pathology and social environment are markers for attentional functioning.
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Chabal S, Hayakawa S, Marian V. How a picture becomes a word: individual differences in the development of language-mediated visual search. Cogn Res Princ Implic 2021; 6:2. [PMID: 33398473 PMCID: PMC7782671 DOI: 10.1186/s41235-020-00268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
Over the course of our lifetimes, we accumulate extensive experience associating the things that we see with the words we have learned to describe them. As a result, adults engaged in a visual search task will often look at items with labels that share phonological features with the target object, demonstrating that language can become activated even in non-linguistic contexts. This highly interactive cognitive system is the culmination of our linguistic and visual experiences-and yet, our understanding of how the relationship between language and vision develops remains limited. The present study explores the developmental trajectory of language-mediated visual search by examining whether children can be distracted by linguistic competitors during a non-linguistic visual search task. Though less robust compared to what has been previously observed with adults, we find evidence of phonological competition in children as young as 8 years old. Furthermore, the extent of language activation is predicted by individual differences in linguistic, visual, and domain-general cognitive abilities, with the greatest phonological competition observed among children with strong language abilities combined with weaker visual memory and inhibitory control. We propose that linguistic expertise is fundamental to the development of language-mediated visual search, but that the rate and degree of automatic language activation depends on interactions among a broader network of cognitive abilities.
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Affiliation(s)
- Sarah Chabal
- Department of Communication Sciences and Disorders, Northwestern University, 2240 North Campus Drive, Evanston, IL, 60208, USA
| | - Sayuri Hayakawa
- Department of Communication Sciences and Disorders, Northwestern University, 2240 North Campus Drive, Evanston, IL, 60208, USA.
| | - Viorica Marian
- Department of Communication Sciences and Disorders, Northwestern University, 2240 North Campus Drive, Evanston, IL, 60208, USA
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