Abstract: Objective To evaluate the effect of neonatal perioperative anesthetic exposure in complex cardiac surgery on
neurodevelopmental outcomes in preschool children. Methods General clinical data and data concerning anesthetic exposure
were collected from 89 infants undergoing complex cardiac surgery at Sichuan People’s Hospital. The cohort was followed for
neurodevelopment till preschool age (48-72 months) and assessed with Wechsler Preschool and Primary Scale of
Intelligence-III, Beery-Buktenica Developmental Test of Visual Motor Integration (VMI-V), and General Adaptive Composite
(GAC) of the Adaptive Behavior Assessment System-II. Results Seventy-one children were enrolled into the final analysis.
Multiple linear regression found days on benzodiazepines (β=-0.49, P=0.005) and cumulative dose of benzodiazepines (β=-0.10,
P=0.023) were associated with the full-scale IQ in these preschool children. Days on benzodiazepines (β=-0.39, P=0.009) and on
chloral hydrate (β =-1.19, P=0.020) were associated with lower performance intelligence quotient (PIQ) at the preschool age.
Cumulative dose of benzodiazepine exposure (β =-0.008, P=0.012) was associated with lower VMI scores. No correlations of
other sedation/analgesia variables were found with the full-scale IQ, PIQ, Verbal IQ, VMI, or GAC scores. Conclusion We
found a significant association of days on benzodiazepines, cumulative dose of benzodiazepines, and days on chloral hydrate
in neonatal cardiac surgery with neurodevelopmental outcomes at the preschool age, suggesting the need of minimizing
anesthetic exposure during a neonatal cardiac surgery to improve the children’s neurodevelopmental outcomes.