{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:18:54Z","timestamp":1787926734662,"version":"build-2784847793"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1038\/s41390-025-04608-7","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T05:21:51Z","timestamp":1763616111000},"page":"277-282","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for emergence delirium in infant-toddlers undergoing sevoflurane anesthesia and its impact on negative postoperative behavioral changes"],"prefix":"10.1038","volume":"100","author":[{"given":"Wanlu","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinji","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weisi","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunpeng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunyu","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyan","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"4608_CR1","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1038\/sj.eye.6703083","volume":"22","author":"AL Mead","year":"2008","unstructured":"Mead, A. L., Chen, S. D., Wilkinson, A. & Patel, C. K. Anaesthesia for the laser treatment of neonates with retinopathy of prematurity. Eye 22, 734 (2008).","journal-title":"Eye"},{"key":"4608_CR2","first-page":"CD007084","volume":"2014","author":"D Costi","year":"2014","unstructured":"Costi, D. et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst. Rev. 2014, CD007084 (2014).","journal-title":"Cochrane Database Syst. Rev."},{"key":"4608_CR3","doi-asserted-by":"publisher","first-page":"169","DOI":"10.4103\/sja.SJA_573_19","volume":"14","author":"SK Aldakhil","year":"2020","unstructured":"Aldakhil, S. K. et al. The prevalence of emergence delirium and its associated factors among children at a postoperative unit: a retrospective cohort at a Middle Eastern hospital. Saudi J. Anaesth. 14, 169\u2013176 (2020).","journal-title":"Saudi J. Anaesth."},{"key":"4608_CR4","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/EJA.0000000000000594","volume":"34","author":"C Aldecoa","year":"2017","unstructured":"Aldecoa, C. et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur. J. Anaesthesiol. 34, 192\u2013214 (2017).","journal-title":"Eur. J. Anaesthesiol."},{"key":"4608_CR5","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1046\/j.1460-9592.2002.00868.x","volume":"12","author":"JW Cole","year":"2002","unstructured":"Cole, J. W., Murray, D. J., McAllister, J. D. & Hirshberg, G. E. Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia. Paediatr. Anaesth. 12, 442\u2013447 (2002).","journal-title":"Paediatr. Anaesth."},{"key":"4608_CR6","doi-asserted-by":"publisher","first-page":"471","DOI":"10.4097\/kja.20097","volume":"73","author":"SJ Lee","year":"2020","unstructured":"Lee, S. J. & Sung, T. Y. Emergence agitation: current knowledge and unresolved questions. Korean J. Anesthesiol. 73, 471\u2013485 (2020).","journal-title":"Korean J. Anesthesiol."},{"key":"4608_CR7","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1093\/bja\/aew477","volume":"118","author":"KP Mason","year":"2017","unstructured":"Mason, K. P. Paediatric emergence delirium: a comprehensive review and interpretation of the literature. Br. J. Anaesth. 118, 335\u2013343 (2017).","journal-title":"Br. J. Anaesth."},{"key":"4608_CR8","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1213\/01.ANE.0000062522.21048.61","volume":"96","author":"T Voepel-Lewis","year":"2003","unstructured":"Voepel-Lewis, T., Malviya, S. & Tait, A. R. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth. Analg. 96, 1625\u20131630 (2003).","journal-title":"Anesth. Analg."},{"key":"4608_CR9","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s00540-015-2098-5","volume":"30","author":"A Kanaya","year":"2016","unstructured":"Kanaya, A. Emergence agitation in children: risk factors, prevention, and treatment. J. Anesth. 30, 261\u2013267 (2016).","journal-title":"J. Anesth."},{"key":"4608_CR10","doi-asserted-by":"publisher","first-page":"1648","DOI":"10.1213\/01.ANE.0000136471.36680.97","volume":"99","author":"ZN Kain","year":"2004","unstructured":"Kain, Z. N. et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth. Analg. 99, 1648\u20131654 (2004).","journal-title":"Anesth. Analg."},{"key":"4608_CR11","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.jclinane.2014.04.006","volume":"29","author":"L Yu","year":"2016","unstructured":"Yu, L., Sun, H., Yao, L. & Feng, Y. An approach to using central pupils as a clinical sign to assess depth of anesthesia in infants undergoing fundus examination with inhalation of sevoflurane. J. Clin. Anesth. 29, 5\u20139 (2016).","journal-title":"J. Clin. Anesth."},{"key":"4608_CR12","doi-asserted-by":"publisher","first-page":"e3","DOI":"10.1016\/j.jamcollsurg.2007.07.034","volume":"205","author":"JA Aldrete","year":"2007","unstructured":"Aldrete, J. A. Post-anesthetic recovery score. J. Am. Coll. Surg. 205, e3\u2013e5 (2007).","journal-title":"J. Am. Coll. Surg."},{"key":"4608_CR13","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/S0952-8180(00)00214-2","volume":"12","author":"ZN Kain","year":"2000","unstructured":"Kain, Z. N., Mayes, L. C., Weisman, S. J. & Hofstadter, M. B. Social adaptability, cognitive abilities, and other predictors for children\u2019s reactions to surgery. J. Clin. Anesth. 12, 549\u2013554 (2000).","journal-title":"J. Clin. Anesth."},{"key":"4608_CR14","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1097\/00000542-200405000-00015","volume":"100","author":"N Sikich","year":"2004","unstructured":"Sikich, N. & Lerman, J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology 100, 1138\u20131145 (2004).","journal-title":"Anesthesiology"},{"key":"4608_CR15","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1111\/j.1460-9592.2010.03328.x","volume":"20","author":"SA Bajwa","year":"2010","unstructured":"Bajwa, S. A., Costi, D. & Cyna, A. M. A comparison of emergence delirium scales following general anesthesia in children. Paediatr. Anaesth. 20, 704\u2013711 (2010).","journal-title":"Paediatr. Anaesth."},{"key":"4608_CR16","first-page":"293","volume":"23","author":"SI Merkel","year":"1997","unstructured":"Merkel, S. I., Voepel-Lewis, T., Shayevitz, J. R. & Malviya, S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr. Nurs. 23, 293\u2013297 (1997).","journal-title":"Pediatr. Nurs."},{"key":"4608_CR17","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1111\/pan.12678","volume":"25","author":"BN Jenkins","year":"2015","unstructured":"Jenkins, B. N. et al. Revisiting a measure of child postoperative recovery: development of the Post hospitalization Behavior Questionnaire for ambulatory surgery. Paediatr. Anaesth. 25, 738\u2013745 (2015).","journal-title":"Paediatr. Anaesth."},{"key":"4608_CR18","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1213\/ANE.0000000000002126","volume":"125","author":"M Hino","year":"2017","unstructured":"Hino, M. et al. Development and validation of a risk scale for emergence agitation after general anesthesia in children: a prospective observational study. Anesth. Analg. 125, 550\u2013555 (2017).","journal-title":"Anesth. Analg."},{"key":"4608_CR19","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.ijso.2020.10.005","volume":"27","author":"D Eshetie","year":"2020","unstructured":"Eshetie, D., Getinet, H., Abdissa, Z. & Mollalign, M. Incidence and associated factors of emergence agitation after general anesthesia and surgery among pediatric patients: a prospective follow-up study. Int. J. Surg. Open. 27, 25\u201331 (2020).","journal-title":"Int. J. Surg. Open."},{"key":"4608_CR20","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1111\/pan.14819","volume":"34","author":"RS Farag","year":"2024","unstructured":"Farag, R. S. et al. Incidence of emergence agitation in children undergoing sevoflurane anesthesia compared to isoflurane anesthesia: an updated systematic review and meta-analysis. Paediatr. Anaesth. 34, 304\u2013317 (2024).","journal-title":"Paediatr. Anaesth."},{"key":"4608_CR21","volume":"2014","author":"D Costi","year":"2014","unstructured":"Costi, D. et al. Middleton P. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst. Rev. 2014, CD007084 (2014).","journal-title":"Cochrane Database Syst. Rev."},{"key":"4608_CR22","doi-asserted-by":"publisher","first-page":"1349105","DOI":"10.3389\/fphar.2024.1349105","volume":"15","author":"X Gao","year":"2024","unstructured":"Gao, X. et al. Electroencephalographic insights into the pathophysiological mechanisms of emergence delirium in children and corresponding clinical treatment strategies. Front. Pharmacol. 15, 1349105 (2024).","journal-title":"Front. Pharmacol."},{"key":"4608_CR23","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1016\/j.clinph.2015.10.041","volume":"127","author":"R Poorun","year":"2016","unstructured":"Poorun, R. et al. Electroencephalography during general anaesthesia differs between term-born and premature-born children. Clin. Neurophysiol. 127, 1216\u20131222 (2016).","journal-title":"Clin. Neurophysiol."},{"key":"4608_CR24","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.bja.2020.07.060","volume":"126","author":"J Kim","year":"2021","unstructured":"Kim, J. et al. Frontal electroencephalogram activity during emergence from general anaesthesia in children with and without emergence delirium. Br. J. Anaesth. 126, 293\u2013303 (2021).","journal-title":"Br. J. Anaesth."},{"key":"4608_CR25","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1016\/j.clinthera.2021.01.024","volume":"43","author":"C Apai","year":"2021","unstructured":"Apai, C., Shah, R., Tran, K. & Pandya Shah, S. Anesthesia and the developing brain: a review of sevoflurane-induced neurotoxicity in pediatric populations. Clin. Ther. 43, 762\u2013778 (2021).","journal-title":"Clin. Ther."},{"key":"4608_CR26","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1213\/ANE.0000000000004053","volume":"128","author":"S Subramaniyan","year":"2019","unstructured":"Subramaniyan, S. & Terrando, N. Neuroinflammation and Perioperative Neurocognitive Disorders. Anesth. Analg. 128, 781\u2013788 (2019).","journal-title":"Anesth. Analg."},{"key":"4608_CR27","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1186\/s12887-023-04434-y","volume":"23","author":"H Yu","year":"2023","unstructured":"Yu, H., Sun, X., Li, P. & Deng, X. Prevalence and risk factors of emergence agitation among pediatric patients undergo ophthalmic and ENT Surgery: a cross-sectional study. BMC Pediatr. 23, 598 (2023).","journal-title":"BMC Pediatr."},{"key":"4608_CR28","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.2147\/DDDT.S357660","volume":"16","author":"Q Xue","year":"2022","unstructured":"Xue, Q., Xia, J., Lu, J. & Shen, X. Added syrup as a flavoring to oral midazolam intravenous solution premedication improves tolerability in pediatric patients. Drug Des. Dev. Ther. 16, 1211\u20131216 (2022).","journal-title":"Drug Des. Dev. Ther."},{"key":"4608_CR29","doi-asserted-by":"publisher","first-page":"3563","DOI":"10.2147\/DDDT.S427291","volume":"17","author":"H He","year":"2023","unstructured":"He, H. et al. The effect of intranasal dexmedetomidine on emergence delirium prevention in pediatric ambulatory dental rehabilitation under general anesthesia: a randomized clinical trial. Drug Des. Dev. Ther. 17, 3563\u20133570 (2023).","journal-title":"Drug Des. Dev. Ther."},{"key":"4608_CR30","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1097\/EJA.0000000000001059","volume":"36","author":"R Eijlers","year":"2019","unstructured":"Eijlers, R. et al. Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: a randomised controlled trial. Eur. J. Anaesthesiol. 36, 728\u2013737 (2019).","journal-title":"Eur. J. Anaesthesiol."},{"key":"4608_CR31","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1001\/jamaoto.2021.0870","volume":"147","author":"E Muzzi","year":"2021","unstructured":"Muzzi, E. et al. Effects of intraoperative auditory stimulation on pain and agitation on awakening after pediatric adenotonsillectomy: a randomized clinical trial. JAMA Otolaryngol. Head. Neck Surg. 147, 638\u2013645 (2021).","journal-title":"JAMA Otolaryngol. Head. Neck Surg."},{"key":"4608_CR32","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1111\/jpc.14948","volume":"56","author":"YY Yang","year":"2020","unstructured":"Yang, Y. Y. et al. Effect of recorded maternal voice on emergence agitation in children undergoing bilateral ophthalmic surgery: a randomised controlled trial. J. Paediatr. Child Health 56, 1402\u20131407 (2020).","journal-title":"J. Paediatr. Child Health"},{"key":"4608_CR33","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/EJA.0000000000001649","volume":"39","author":"LG Larsen","year":"2022","unstructured":"Larsen, L. G., Wegger, M., L\u00e9 Greves, S., Erngaard, L. & Hansen, T. G. Emergence agitation in paediatric day case surgery: a randomised, single-blinded study comparing narcotrend and heart rate variability with standard monitoring. Eur. J. Anaesthesiol. 39, 261\u2013268 (2022).","journal-title":"Eur. J. Anaesthesiol."}],"container-title":["Pediatric Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41390-025-04608-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-025-04608-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-025-04608-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:19:54Z","timestamp":1787923194000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41390-025-04608-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["4608"],"URL":"https:\/\/doi.org\/10.1038\/s41390-025-04608-7","relation":{},"ISSN":["0031-3998","1530-0447"],"issn-type":[{"value":"0031-3998","type":"print"},{"value":"1530-0447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]},"assertion":[{"value":"4 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 November 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"This study was approved by the Ethics Committee of Peking University People\u2019s Hospital (Approval No. 2024PHB133\u2009\u2212\u2009001). Written informed consent was obtained from the legal guardian of the children before they were enrolled in the study.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Ethics"}}]}}