Objective To investigate the correlation between general anesthesia and neurodevelopmental outcomes in
children. Methods This retrospective cohort study included children under 3 years old who received general anesthesia in
our hospital from January 2017 to December 2020 as the anesthesia group, and outpatient or inpatient children aged 3 to 6
years old who did not receive general anesthesia during September 2022 to August 2023 as the control group. From September
2022 to August 2023, the study population was assessed for abnormal neurodevelopmental outcomes by the mental
developmental screening test (DST) at 0-6 years of age. The DST evaluated gross motor, fine motor, language, adaptive
behavior, and social and self-care. The t-tests were conducted to compare scores on different dimensions between the two
groups. Linear regression analyses were performed to assess the associations between general anesthesia and children's
neurodevelopmental outcomes after adjusting for con-founders. Stratified analyses were conducted to explore the impact of
general anesthesia on neurodevelopmental outcomes in children based on different age ranges of exposure. Results A total of
336 children participated in the study, with 132 in the control group and 204 in the anesthesia group. The testing age was
(4.8±1.2) years in both the control and anesthesia groups, and there was no statistically significant difference (P>0.05)
.Compared with control group, children in the anesthesia group had lower scores in fine motor, adaptive behavior, language,
and social and self-care, with statistically significant difference (P<0.05). After adjusting for con-founders, the effects of
anesthesia on the adaptive behavior and language remained significant (P<0.05). Stratification analysis according to the age
at the time of anesthesia showed that general anesthesia at 0-1 year old was associated with lower scores of adaptive behavior
and social and self-care factors (P<0.05), and general anesthesia at 2 to 3 years old was associated with lower language
factor scores (P<0.05). Conclusion Exposure to general anesthesia at an early age (<3 years old) is associated with poor
neurocognition in adaptive behavior and language. General anesthesia at different ages has different effects on the
development of specific nerve functional areas.