Skip to main content
SpringerLink
Log in

Anesthesia Management in Severe Prematurity

  • Chapter
Pediatric Anesthesia, Intensive Care and Pain: Standardization in Clinical Practice

  • 2254 Accesses

Abstract

Over the last 30 years, greater numbers of premature infants of decreasing gestational age and extremely low birth weight (ELBW) have survived thanks to advances in neonatal intensive care and obstetrics. The increased survival of premature neonates has produced a population of infants who are susceptible to many unique diseases and a host of potential anesthetic challenges. With this increased survival rate, the need for infants to undergo surgery is not infrequent. It may be performed for surgical ligation of a patent ductus arteriosus (PDA), which is causing severe heart failure not controlled by medical therapy, or a laparotomy for the consequences of necrotizing enterocolitis (NEC).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Peevy KJ, FA Speed, CJ Hoff (1986) Epidemiology of inguinal hernia in preterm neonates. Pediatrics, 77(2):246–247

    PubMed  CAS  Google Scholar 

  2. Boat AC et al. (2011) Outcome for the extremely premature neonate: how far do we push the edge? Paediatr Anaesth, 21(7):765–770

    Article  PubMed  Google Scholar 

  3. Gregory, ed. Pediatric Anestesia

    Google Scholar 

  4. El-Metwally D, B Vohr, R Tucker, (2000) Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks. J Pediatr, 137(5):616–622

    Article  PubMed  CAS  Google Scholar 

  5. Lemons JA et al. (2001) Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics 107(1):E1

    Article  Google Scholar 

  6. Kurth CD et al. (1987) Postoperative apnea in preterm infants. Anesthesiology 66(4):483–488

    Article  PubMed  CAS  Google Scholar 

  7. Rigatto H, JP Brady (1972 )Periodic breathing and apnea in preterm infants. II. Hypoxia as a primary event. Pediatrics 50(2):219–228

    PubMed  CAS  Google Scholar 

  8. Daily WJ, M Klaus, HB Meyer (1969) Apnea in premature infants: monitoring, incidence, heart rate changes, and an effect of environmental temperature. Pediatrics, 43(4):510–518

    PubMed  CAS  Google Scholar 

  9. Gallagher, TM and PM Crean, (1989 ) Spinal anaesthesia in infants born prematurely. Anaesthesia 44(5):434–436

    Article  PubMed  CAS  Google Scholar 

  10. Kurth CD, SE LeBard (1991) Association of postoperative apnea, airway obstruction, and hypoxemia in former premature infants. Anesthesiology 75(1):22–26

    Article  PubMed  CAS  Google Scholar 

  11. Cote CJ et al. (1995) Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology 82(4):809–822

    Article  PubMed  CAS  Google Scholar 

  12. Welborn LG et al. (1991) Anemia and postoperative apnea in former preterm infants. Anesthesiology 74(6):1003–1006

    Article  PubMed  CAS  Google Scholar 

  13. Wells JT, LR Ment, (1995).Prevention of intraventricular hemorrhage in preterm infants. Early Hum Dev 42(3):209–233

    Article  PubMed  CAS  Google Scholar 

  14. Kaiser JR et al. (2006) Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants. J Perinatol 26(5):279–285

    Article  PubMed  CAS  Google Scholar 

  15. Lermann VL, JB Fortes Filho, RS Procianoy (2006) The prevalence of retinopathy of prematurity in very low birth weight newborn infants. J Pediatr (Rio J), 82(1):27–32

    Article  Google Scholar 

  16. Whitfill CR, AV Drack (2000) Avoidance and treatment of retinopathy of prematurity. Semin Pediatr Surg 9(2):103–105

    PubMed  CAS  Google Scholar 

  17. Nair PM et al. (2003) Retinopathy of prematurity in VLBW and extreme LBW babies. Indian J Pediatr 70(4):303–306

    Article  PubMed  CAS  Google Scholar 

  18. Cunningham S et al. (1995 ) Transcutaneous oxygen levels in retinopathy of prematurity. Lancet 346(8988):1464–1465

    Article  PubMed  CAS  Google Scholar 

  19. Snyder CL et al. (1997) Survival after necrotizing enterocolitis in infants weighing less than 1,000 g: 25 years’ experience at a single institution. J Pediatr Surg 32(3):434–437

    Article  PubMed  CAS  Google Scholar 

  20. Guthrie SO et al. (2003) Necrotizing enterocolitis among neonates in the United States. J Perinatol 23(4):278–285

    Article  PubMed  Google Scholar 

  21. Ohlson K.B et al. (1994) Thermogenesis in brown adipocytes is inhibited by volatile anesthetic agents. A factor contributing to hypothermia in infants? Anesthesiology 81(1):176–183

    CAS  Google Scholar 

  22. Dicker A et al. (1995) Halothane selectively inhibits nonshivering thermogenesis. Possible implications for thermoregulation during anesthesia of infants. Anesthesiology 82(2):491–501

    Article  PubMed  CAS  Google Scholar 

  23. Ohlson KB et al. (2003) Thermogenesis inhibition in brown adipocytes is a specific property of volatile anesthetics. Anesthesiology 98(2):437–448

    Article  PubMed  CAS  Google Scholar 

  24. Jahnukainen T et al. (1993) Dynamics of vasomotor thermoregulation of the skin in term and preterm neonates. Early Hum Dev 33(2):133–143

    Article  PubMed  CAS  Google Scholar 

  25. Trus T et al. (1993) Optimal management of patent ductus arteriosus in the neonate weighing less than 800 g. J Pediatr Surg 28(9):1137–1379

    Article  PubMed  CAS  Google Scholar 

  26. Radtke WA, (1998) Current therapy of the patent ductus arteriosus. Curr Opin Cardiol 13(1):59–65

    Article  PubMed  CAS  Google Scholar 

  27. Stevenson JG ( 1977) Fluid administration in the association of patent ductus arteriosus complicating respiratory distress syndrome. J Pediatr 90(2):257–261

    Article  PubMed  CAS  Google Scholar 

  28. Heymann MA, AM Rudolph, NH Silverman (1976) Closure of the ductus arteriosus in premature infants by inhibition of prostaglandin synthesis. N Engl J Med 295(10):530–533

    Article  PubMed  CAS  Google Scholar 

  29. Merritt TA et al. (1978) Closure of the patent ductus arteriosus with ligation and indomethacin: a consecutive experience. J Pediatr 93(4):639–646

    Article  PubMed  CAS  Google Scholar 

  30. Ohlsson A, R Walia, S Shah (2008) Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev (1):CD003481

    Google Scholar 

  31. Little DC et al. (2009) Patent ductus arteriosus in micropreemies and full-term infants: the relative merits of surgical ligation versus indomethacin treatment. J Pediatr Surg 2003. 38(3):492–496

    Article  Google Scholar 

  32. Benjacholmas V et al. (2009) Short-term outcome of PDA ligation in the preterm infants at King Chulalongkorn Memorial Hospital, Thailand. J Med Assoc Thai 92(7):909–913

    PubMed  Google Scholar 

  33. Cote-Lerman-Todres (2003) Practice of Anesthesia in Infants and Children IV edition

    Google Scholar 

  34. Gould DS et al. (2003) A comparison of on-site and off-site patent ductus arteriosus ligation in premature infants. Pediatrics 112(6 Pt 1):1298–1301

    Article  PubMed  Google Scholar 

  35. Spector SA, W Ticknor, M Grossman (1981) Study of the usefulness of clinical and hematologic findings in the diagnosis of neonatal bacterial infections. Clin Pediatr (Phila) 20(6):385–392

    Article  CAS  Google Scholar 

  36. Avery GB (1988) Neonatology in the NICU: three new techniques, three continuing problems. Pediatr Ann 17(8):503

    PubMed  CAS  Google Scholar 

  37. Schlapbach LJ et al. (2011) Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants. Pediatrics 128(2):e348-357

    Article  PubMed  Google Scholar 

  38. Jilani T, MP etal (2011) Does vitamin E have a role in treatment and prevention of anemia? Pak J Pharm Sci 24(2):237–242

    PubMed  CAS  Google Scholar 

  39. Watchko JF, FA Oski (1992) Kernicterus in preterm newborns: past, present, and future. Pediatrics 90(5):707–715

    PubMed  CAS  Google Scholar 

  40. Gartner LM et al. (1970) Kernicterus: high incidence in premature infants with low serum bilirubin concentrations. Pediatrics 45(6):906–917

    PubMed  CAS  Google Scholar 

  41. Okumura A et al. (2009) Kernicterus in preterm infants. Pediatrics 123(6):e1052-1058

    Article  PubMed  Google Scholar 

  42. Parigi GB, chirurgia pediatrica Masson

    Google Scholar 

  43. Lorenz JM (2001) The outcome of extreme prematurity. Semin Perinatol 25(5):348–359

    Article  PubMed  CAS  Google Scholar 

  44. LeDez K.M, J Lerman (1987) The minimum alveolar concentration (MAC) of isoflurane in preterm neonates. Anesthesiology 67(3):301–307

    Article  PubMed  CAS  Google Scholar 

  45. Loepke AW, FX McGowan Jr, SG Soriano (2008) CON: The toxic effects of anesthetics in the developing brain: the clinical perspective. Anesth Analg 106(6):1664–1669

    Article  PubMed  Google Scholar 

  46. Loepke AW (2010) Developmental neurotoxicity of sedatives and anesthetics: a concern for neonatal and pediatric critical care medicine? Pediatr Crit Care Med 11(2):217–226

    Article  PubMed  Google Scholar 

  47. Loepke AW et al. (2009).The effects of neonatal isoflurane exposure in mice on brain cell viability, adult behavior, learning, and memory. Anesth Analg, 108(1):90–104

    Article  PubMed  CAS  Google Scholar 

  48. Jevtovic-Todorovic V, JW Olney (2008) PRO: Anesthesia-induced developmental neuroapoptosis: status of the evidence. Anesth Analg 106(6):1659–1663

    Article  PubMed  Google Scholar 

  49. DiMaggio C et al. (2009) A retrospective cohort study of the association of anesthesia and hernia repair surgery with behavioral and developmental disorders in young children. J Neurosurg Anesthesiol 21(4):286–291

    Article  PubMed  Google Scholar 

  50. Wilder RT et al. (2009) Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology 110(4):796–804

    Article  PubMed  Google Scholar 

  51. Sprung J et al. (2009) Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort. Anesthesiology 111(2):302–310

    Article  PubMed  Google Scholar 

  52. Bartels M, RR Althoff, DI Boomsma (2009) Anesthesia and cognitive performance in children: no evidence for a causal relationship. Twin Res Hum Genet 12(3):246–253

    Article  PubMed  Google Scholar 

  53. Ikonomidou C et al. (2001) Neurotransmitters and apoptosis in the developing brain. Biochem Pharmacol 62(4):401–405

    Article  PubMed  CAS  Google Scholar 

  54. Ikonomidou C et al. (1999) Blockade of NMDA receptors and apoptotic neurodegeneration in the developing brain. Science 283(5398):70–74

    Article  PubMed  CAS  Google Scholar 

  55. Anand KJ (2000) Pain, plasticity, and premature birth: a prescription for permanent suffering? Nat Med 6(9):971–973

    Article  PubMed  CAS  Google Scholar 

  56. Anand K.S (1993) Relationships between stress responses and clinical outcome in newborns, infants, and children. Crit Care Med 21(9 Suppl):S358-S359

    Article  PubMed  CAS  Google Scholar 

  57. Bosenberg AT (1998) Epidural analgesia for major neonatal surgery. Paediatr Anaesth 8(6):479–483

    Article  PubMed  CAS  Google Scholar 

  58. Huang JJ, G Hirshberg (2001) Regional anaesthesia decreases the need for postoperative mechanical ventilation in very low birth weight infants undergoing herniorrhaphy. Paediatr Anaesth 11(6):705–709

    Article  PubMed  CAS  Google Scholar 

  59. Webster AC et al. (1993) Lumbar epidural anaesthesia for inguinal hernia repair in low birth weight infants. Can J Anaesth 40(7):670–675

    Article  PubMed  CAS  Google Scholar 

  60. Welborn LG et al. (1990) Postoperative apnoea in former preterm infants: does anaemia increase the risk? Can J Anaesth 37(4 Pt 2):S92

    PubMed  CAS  Google Scholar 

  61. Veverka TJ et al. (1991) Spi nal anesthesia reduces the hazard of apnea in high-risk infants. Am Surg 57(8):531–534; discussion 534–535

    PubMed  CAS  Google Scholar 

  62. Krane EJ, CM Haberkern, LE Jacobson (1995) Postoperative apnea, bradycardia, and oxygen desaturation in formerly premature infants: prospective comparison of spinal and general anesthesia. Anesth Analg 80(1):7–13

    PubMed  CAS  Google Scholar 

  63. Hoelzle M et al. (2010) Comparison of awake spinal with awake caudal anesthesia in preterm and ex-preterm infants for herniotomy. Paediatr Anaesth 20(7):620–624

    Article  PubMed  Google Scholar 

  64. Walther-Larsen S, LS Rasmussen (2006) The former preterm infant and risk of post-operative apnoea: recommendations for management. Acta Anaesthesiol Scand 50(7):888–893

    Article  PubMed  CAS  Google Scholar 

  65. Steward DJ (1982) Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiology, 56(4):304–306

    Article  PubMed  CAS  Google Scholar 

  66. Somri M et al. (1998) Postoperative outcome in high-risk infants undergoing herniorrhaphy: comparison between spinal and general anaesthesia. Anaesthesia 53(8):762–766

    Article  PubMed  CAS  Google Scholar 

  67. Sale SM et al. (2006) Prospective comparison of sevoflurane and desflurane in formerly premature infants undergoing inguinal herniotomy. Br J Anaesth 96(6):774–778

    Article  PubMed  CAS  Google Scholar 

  68. Andrew M (1997) The relevance of developmental hemostasis to hemorrhagic disorders of newborns. Semin Perinatol 21:70–85

    Article  PubMed  CAS  Google Scholar 

  69. Andrew M, Vegh P, Johnston M, et al. (1992) Maturation of the hemostatic system during childhood. Blood 80:1998–2005

    PubMed  CAS  Google Scholar 

  70. Goodnight SH, Hathaway WE (2001) Disorders of Hemostasis and Thrombosis, A Clinical Guide, 2nd ed. New York, McGraw-Hill, pp 31–38

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Anesthesia and Intensive Care, Pediatric Anesthesia and Intensive Care Section, and Postgraduate School, University of Catania, AOU Policlinico-Vittorio Emanuele, Catania, Italy

    Marinella Astuto

Authors
  1. Marinella Astuto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Concetta Gullo
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Anesthesia and Intensive Care, Pediatric Anesthesia and Intensive Care Section, and Postgraduate School, University of Catania, AOU Policlinico-Vittorio Emanuele, Catania, Italy

    Marinella Astuto

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Italia

About this chapter

Cite this chapter

Astuto, M., Gullo, C. (2013). Anesthesia Management in Severe Prematurity. In: Astuto, M. (eds) Pediatric Anesthesia, Intensive Care and Pain: Standardization in Clinical Practice. Anesthesia, Intensive Care and Pain in Neonates and Children. Springer, Milano. https://doi.org/10.1007/978-88-470-2685-8_15

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2685-8_15

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2684-1

  • Online ISBN: 978-88-470-2685-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation