{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:44:47Z","timestamp":1791398687186,"version":"4.3.3"},"reference-count":44,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2017,7,1]],"date-time":"2017-07-01T00:00:00Z","timestamp":1498867200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Early life exposure to anesthesia and surgery is suspected to associate with cognitive impairment later in life. We compared academic achievement among adolescents with cleft lip only (CL), cleft palate only (CP), and cleft lip and cleft palate (CLP) with a noncleft control group to investigate whether outcome depends on timing and number of operations during childhood and\/or type of oral cleft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nationwide register-based follow-up study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Danish birth cohort 1986 to 1990.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Five hundred fifty-eight children with isolated CL (n = 171), CLP (n =222), or CP (n = 195), of which 509 children had been exposed to anesthesia and one or more cleft operation(s), and a 5% sample of the birth cohort (n = 14,677).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s)<\/jats:title>\n                    <jats:p>Test score in the Danish standardized ninth-grade exam and proportion of nonattainment, defined as \u201cresults for ninth-grade exam unavailable.\u201d Data adjusted for sex, birth weight, parental age, and parental level of education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to controls, children with CL achieved higher scores (mean difference 0.12, 95% CI \u20130.05; 0.29) and children with CLP presented with lower scores (mean difference \u20130.06, 95% CI \u20130.21; 0.09), albeit both statistically insignificant. Children with CP achieved significantly lower scores, mean difference \u20130.20 (95% CI \u20130.38; \u20130.03). Odds ratios for nonattainment at final exam were: CL 0.79 (95% CI 0.46; 1.35), CLP 1.07 (95% CI 0.71; 1.61), CP 2.59 (95% CI 1.78; 3.76).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Oral cleft type rather than number and timing of anesthesia and operations associate to poorer academic performance. Although a potential neurotoxic effect due to anesthetic agents is not reflected in the data, it cannot be completely excluded.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1597\/15-185","type":"journal-article","created":{"date-parts":[[2016,4,4]],"date-time":"2016-04-04T17:05:06Z","timestamp":1459789506000},"page":"371-380","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":46,"title":["Oral Clefts and Academic Performance in Adolescence: The Impact of Anesthesia-Related Neurotoxicity, Timing of Surgery, and Type of Oral Clefts"],"prefix":"10.1177","volume":"54","author":[{"given":"Nicola G.","family":"Clausen","sequence":"first","affiliation":[{"name":"Department of Anesthesia & Intensive Care, Odense University Hospital, Odense C, Denmark, and Institute for Clinical Research Anesthesiology, University of Southern Denmark, Odense C"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorthe A.","family":"Pedersen","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Southern Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob K.","family":"Pedersen","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Southern Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne E.","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Southern Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorthe","family":"Grosen","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Lillebaelt Hospital, Kolding, and Epidemiology, Institute of Public Health, University of Southern Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaare","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Southern Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom G.","family":"Hansen","sequence":"additional","affiliation":[{"name":"University of Southern Denmark, Odense C, Denmark, and Consultant Pediatric Anesthesiologist, Department of Anesthesia & Intensive Care, Odense University Hospital, Odense C, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George L.","family":"Wehby","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,7,1]]},"reference":[{"key":"bibr1-15-185","first-page":"263","volume":"46","author":"Andersen T.F.","year":"1999","journal-title":"Dan Med Bull."},{"key":"bibr2-15-185","doi-asserted-by":"publisher","DOI":"10.1375\/twin.12.3.246"},{"key":"bibr3-15-185","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000326"},{"key":"bibr4-15-185","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_1999_036_0096_tcdfcp_2.3.co_2"},{"key":"bibr5-15-185","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38959.650903.7C"},{"key":"bibr6-15-185","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_2003_040_0481_ssaoci_2.0.co_2"},{"key":"bibr7-15-185","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsu049"},{"key":"bibr8-15-185","unstructured":"Danish Ministry of Education. Tests, assessment and teaching: an overall evaluation of compulsory school completion assessment and test scores May\u2013June 2004 [in Danish]. 2006."},{"key":"bibr9-15-185","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00608-X"},{"key":"bibr10-15-185","doi-asserted-by":"publisher","DOI":"10.1097\/ANA.0b013e3181a71f11"},{"key":"bibr11-15-185","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-0351"},{"key":"bibr12-15-185","first-page":"120","author":"Glatz P.","year":"2015","journal-title":"Anesth Analg."},{"key":"bibr13-15-185","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12548"},{"key":"bibr14-15-185","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12225"},{"key":"bibr15-15-185","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12533"},{"key":"bibr16-15-185","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31820e77a0"},{"key":"bibr17-15-185","doi-asserted-by":"publisher","DOI":"10.1037\/a0015362"},{"key":"bibr18-15-185","doi-asserted-by":"publisher","DOI":"10.1126\/science.283.5398.70"},{"key":"bibr19-15-185","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-3822"},{"key":"bibr20-15-185","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000248"},{"key":"bibr21-15-185","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810394715"},{"key":"bibr22-15-185","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e3283487247"},{"key":"bibr23-15-185","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.23-03-00876.2003"},{"key":"bibr24-15-185","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e3181731ff2"},{"key":"bibr25-15-185","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2006.01.008"},{"key":"bibr26-15-185","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31819c7124"},{"key":"bibr27-15-185","doi-asserted-by":"publisher","DOI":"10.1597\/13-293"},{"key":"bibr28-15-185","first-page":"265","volume":"20","author":"Kolb B.","year":"2011","journal-title":"J Can Acad Child Adolesc Psychiatry."},{"key":"bibr29-15-185","doi-asserted-by":"publisher","DOI":"10.1597\/14-126"},{"key":"bibr30-15-185","doi-asserted-by":"publisher","DOI":"10.1097\/ANA.0000000000000122"},{"key":"bibr31-15-185","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811401482"},{"key":"bibr32-15-185","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000255729.96438.b0"},{"key":"bibr33-15-185","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12325"},{"key":"bibr34-15-185","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.161.8.753"},{"key":"bibr35-15-185","first-page":"441","volume":"53","author":"Pedersen C.B.","year":"2006","journal-title":"Dan Med Bull."},{"key":"bibr36-15-185","doi-asserted-by":"publisher","DOI":"10.1597\/09-047"},{"key":"bibr37-15-185","volume-title":"The Danish Demographic Database: Longitudinal Data for Advanced Demographic Methods.","author":"Petersen J.","year":"2000"},{"key":"bibr38-15-185","doi-asserted-by":"publisher","DOI":"10.1597\/10-237"},{"key":"bibr39-15-185","unstructured":"Statistics Denmark. 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