Neonatal anaesthesia and the ex-preterm infant

Meet the patient

A baby born at 28 weeks, now 16 weeks old, is listed for an inguinal hernia repair. The surgical team book him as a "three-month-old day case". He is not — his post-menstrual age is 44 weeks, his breathing control is still immature, and sending him home the same afternoon after a general anaesthetic is the classic examinable safety failure.[1]

The single question that decides this baby's disposition is what is the post-menstrual age, and is it below the overnight-monitoring threshold? Everything else — glucose, temperature, oxygen targeting, opioid sparing — protects a baby whose apnoea centre is not yet reliable. Get the age vocabulary right first, and the plan writes itself.[1]

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1. [1]Coté CJ, Zaslavsky A, Downes JJ, et al. Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis Anesthesiology, 1995.PMID 7717551
2. [2]Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial Lancet, 2016.PMID 26507180
3. [3]McCann ME, de Graaff JC, Dorris L, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial Lancet, 2019.PMID 30782342
4. [4]Flick RP, Wilder RT, Pieper SF, et al. Risk factors for laryngospasm in children during general anesthesia Paediatr Anaesth, 2008.PMID 18315633
5. [5]Sikich N, Lerman J Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale Anesthesiology, 2004.PMID 15114210