Neonatal anaesthesia and the ex-preterm infant

Model answer

Risk (5). At 42 weeks PMA this ex-28-weeker sits deep in the apnoea window: in nonanaemic infants free of recovery-room apnoea, Cote's combined analysis put the risk at no less than 5% (95% confidence) until 48 weeks postconceptual age at gestational age 35, and no less than 1% until 56 weeks at gestational age 32. Review bronchopulmonary dysplasia, apnoeas, anaemia, intercurrent respiratory infection and airway anomaly — the last two raise laryngospasm risk (upper respiratory infection OR 2.03, airway anomaly OR 3.35).^[4][3]

Anaesthesia (5). Awake-regional versus sevoflurane general anaesthesia: GAS showed equivalent neurodevelopment — 5-year full-scale IQ 99.1 versus 99.0 after about an hour of sevoflurane in infancy, with 2-year equivalence too. Neither technique harms the developing brain on this evidence; the choice rests on the airway, the anaemia, and the monitoring plan.^[1][2]

Disposition (5). Admit for prolonged cardiorespiratory monitoring — not a day case at 42 weeks PMA — especially with anaemia or any recovery-room apnoea.^[4]