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Studying cognitive impairments during brain development faces significant challenges due to the dynamic nature of neurodevelopment, methodological constraints, and contextual barriers. Brain development involves rapid, non-linear changes, complicating the identification of impairments during critical windows1,2. In low-resource settings, barriers like caregiver literacy, linguistic diversity, and limited access to specialized tools (e.g., MRI) hinder early screening1. Individual variability in brain maturation makes it difficult to distinguish pathological deviations from typical development2,3. Conditions like Down syndrome exhibit altered cortical development, but small sample sizes and scarce histological data limit mechanistic insights4. Neurodevelopmental disorders (e.g., ASD, ADHD) often co-occur with anxiety or depression, confounding cognitive assessments5. Severe communication deficits in some populations restrict the use of standardized tests6. Those features lead to several research design issues. Indeed, most studies use cross-sectional designs, failing to model within-individual change over time. There is an overreliance on Western, educated populations ("WEIRD" samples)7. Down syndrome research suffers from small post-mortem brain samples and inadequate age-matched controls4. Ecological momentary assessment tools struggle to account for contextual variables affecting daily cognitive performance5.
The most important functions in the animal and human brain include learning and memory, which are central to human development and life in general8. The brain of infants is in the developmental stage and is vulnerable to external factors like drugs and anesthesia9,10. The damage caused by anesthetics to infants' memory function is a crucial clinical research topic and can even delay optimal treatments for pediatric patients due to the inability to perform anesthesia11. Anesthesia-related cognitive dysfunctions (or postoperative cognitive dysfunction, POCD) may have long-term consequences for infants12. Sevoflurane inhalation can affect memory functions in infants13,14, but traditional anesthesiology believes that brain damage in infants is mainly caused by brain hypoxia during anesthesia, especially in general anesthesia10. Therefore, as long as there is no short-term or long-term hypoxia in the brain, the risk of central nervous system injury in infants should be reduced11. Still, the understanding of POCD remains suboptimal. Infants requiring surgery will require anesthesia, and a better knowledge of the pathways involved could help design anesthesia strategies that would minimize the risk of POCD.
A study involving older adult patients who underwent non-cardiac surgeries revealed that nearly 25% of patients experienced POCD within 1 week after surgery, and the proportion decreased to below 10% after 3 months, while the control group showed POCD rates of 3.4% and 2.8%15. The study also indicated that most POCD cases were reversible, with only a small number of patients experiencing prolonged or permanent POCD15. In the central nervous system, glutamate is the most common excitatory amino acid16. The N-methyl-D-aspartate receptor (NMDAR) is crucial for the induction and maintenance of long-term potentiation (LTP) and long-term depression (LTD)17. Research on mice showed that excitatory synaptic plasticity directly affects brain function development18, with NMDAR activation and calcium influx being particularly important19,20. Enhanced NMDAR activity has significant implications for inducing synaptic growth and plasticity19,20. Therefore, a higher degree of NMDAR blockade by NMDAR antagonists (e.g., sevoflurane) should result in lower learning and memory abilities21. While the effects of sevoflurane on learning and memory in adult brains have not reached a clear conclusion22,23, sevoflurane is commonly used for anesthesia in pediatric surgeries14. As a non-competitive antagonist of NMDAR, sevoflurane can significantly affect the brain's learning and memory functions11,13,14,23,24. Nevertheless, besides NMDAR, other pathways and proteins are involved in learning and memory, and the mechanisms of memory regulation involving phosphorylated-cAMP response element-binding protein (p-CREB) and immediate early gene c-fos are becoming clearer25,26,27, but still require a better understanding for optimal anesthesia delivery in infants and children.
Based on these theoretical frameworks, the present study investigated an integrated methodological approach that could be used to study cognitive impairments in the developing brain caused by sevoflurane based on memory and p-CREB and c-fos expression in hippocampal neurons through the NMDAR/p-CREB/c-fos signaling pathway in juvenile rats. The results could help improve our understanding of POCD and memory impairment after general anesthesia. This study used 21-day-old rats because they had just been weaned and had a highly uniform body weight and physiological status, corresponding to early adolescence in humans. Due to their heightened neuroplasticity and vulnerability during this critical developmental period, they can efficiently model the cognitive impairments caused by surgery or anesthesia on the immature brain28,29. This makes them particularly suitable for studying the neurocognitive risks associated with pediatric surgery and exploring potential intervention strategies. The Y-maze is a commonly used method to assess learning and memory30. Immunohistochemistry is commonly used to study neurons and various neuronal proteins.