Skip to main content

Anesthesia Considerations in a Premie

  • Chapter
  • First Online:
Anesthesiology

Abstract

A preterm infant is one born prior to 37 weeks of gestation. According to a 2015 Centers for Disease Control and Prevention report, one out of every ten infants born in the United States was a preterm infant. Even though there have been dramatic declines in the infant mortality rate due to better obstetric care and significant advances in neonatal intensive care units, death from prematurity is a leading cause of infant mortality. This infant mortality rate is inversely proportional to gestational age, but recent studies have shown that there is a slight improvement in the survival rates of the early preterm infants with an associated decrease in their neurodevelopmental impairment (Younge et al., N Engl J Med 376:617–628, 2017). The premature infants (“preemies”) who survive have a high likelihood of requiring a variety of surgical procedures. Caring for a preterm neonate poses an anesthetic challenge not only due to the infant’s size, but also due to incomplete organogenesis and immature physiology.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover 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. Younge N, Goldstein RF, Bann CM, Hintz SR. Survival and neurodevelopment outcomes among periviable infants. N Engl J Med. 2017;376:617–28.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res. 2010;67(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Adams-Chapman I, Hansen NI, Stoll BJ, Higgins R. Neurodevelopmental outcome of extremely low birth weight infants with post hemorrhagic hydrocephalus requiring shunt insertion. Pediatrics. 2008;121(5):1167–77.

    Article  Google Scholar 

  4. Derbyshire SW. Can Fetuses feel pain? BMJ. 2006;332:909–12.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Giannakoulopoulos X, Sepulveda W, Kourtis P, Glover V, Fisk NM. Fetal plasma cortisol and β-endorphin response to intrauterine needling. Lancet. 1994;344:77–81.

    Article  CAS  PubMed  Google Scholar 

  6. Carroll JL, Agarwal A. Development of ventilatory control in infants. Paediatr Respir Rev. 2010;11:199–207.

    Article  PubMed  Google Scholar 

  7. Nock ML, Difiore JM, Arko K, Martin RJ. Relationship of the ventilatory response to hypoxia with neonatal apnea in preterm infants. J Pediatr. 2004;144(3):291–5.

    Article  PubMed  Google Scholar 

  8. Wallace DK. Anti-VEGF treatment for ROP: which drug and what dose? J AAPOS. 2016;20(6):476–8.

    Article  PubMed  Google Scholar 

  9. Murphy PJ. The fetal circulation. Contin Edcu Anaesth Crit Care Pain. 2005;5(4):107–12.

    Article  Google Scholar 

  10. Laughon MM, Simmons MA, Bose CL. Patency of the ductus arteriosus in premature infant: is it pathologic? Should it be treated? Curr Opin Pediatr. 2004;16(2):146–51.

    Article  PubMed  Google Scholar 

  11. Thébaud B, Lacaze-Mazmonteil T. Patent ductus arteriosus in premature infants: a never closing act. Paediatr Child Health. 2010;15(5):267–70.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ruegger C, Bucher HU, Mieth RA. Pulse oximetry in the newborn: is the left hand pre- or post-ductal? BMC Pediatr. 2010;10:35–41.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Collin AA, McEvoy C, Castile RG. Respiratory morbidity and lung function in preterm infants of 32 to 36 weeks’ gestational age. Pediatrics. 2010;126(1):115–28.

    Article  Google Scholar 

  14. Polin RA, Carlo WA, Committee on Fetus and Newborn, American Academy of Pediatrics. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133(1):156–63.

    Article  PubMed  Google Scholar 

  15. Poggi C, Giusti B, Gozzini E, Sereni A. Genetic contributions to the development of complications in preterm neonates. PLoS One. 2015;10(7):e0131741.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Merrill JD, Ballard RA, Cnaan A, Hibbs AM. Dysfunction of pulmonary surfactant in chronically ventilated premature infants. Pediatr Res. 2004;56(6):918–26.

    Article  CAS  PubMed  Google Scholar 

  17. Stenson B, Brocklehurst P, Tarnow-Mordi W. Increased 36-week survival with high oxygen saturation target in extremely preterm infants. N Engl J Med. 2011;364(17):1680–2.

    Article  CAS  PubMed  Google Scholar 

  18. Darlow BA, Morley CJ. Oxygen saturation targeting and bronchopulmonary dysplasia. Clin Perinatol. 2015;42(4):807–23.

    Article  PubMed  Google Scholar 

  19. Musso CG, Ghezzi L, Ferraris J. Renal physiology in newborns and old people: similar characteristics but different mechanisms. Int Urol Nephrol. 2004;36(2):273–6.

    Article  PubMed  Google Scholar 

  20. Gregory GA, Brett C. Neonatology for anesthesiologists. In: Davis P, Cladis F, editors. Smith’s anesthesia for infants and children. 9th ed. Philadelphia: Elsevier; 2016. p. 513–70.

    Google Scholar 

  21. Oh W. Fluid and electrolyte therapy in low birth weight infants. Pediatr Rev. 1980;1:313.

    Article  Google Scholar 

  22. Yao AC, Lind J, Tiisala R, Michelsson K. Placental transfusion in the premature infant with observation on clinical course and outcome. Acta Paediatr Scand. 1969;58(6):561–6.

    Article  CAS  PubMed  Google Scholar 

  23. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev. 2012;(8):CD003248.

    Google Scholar 

  24. Laptook AR, Salhab W, Bhaskar B, Neonatal Research Network. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 2007;119(3):e643–9.

    Article  PubMed  Google Scholar 

  25. Chang HY, Sung YH, Wang SM, Lung HL. Short and long term outcomes in very low birth weight infants with admission hypothermia. PLoS One. 2015;10(7):e0131976.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Mehta S, Connors AF, Danish EH, Grisoni E. Incidence of thrombosis during central venous catheterization of newborns, a prospective study. J Pediatr Surg. 1992;27(1):18–22.

    Article  CAS  PubMed  Google Scholar 

  27. Giris KK. Ultrasound guidance versus transillumination for peripheral intravenous cannulation in pediatric patients with difficult venous access. Egyptian J Cardiothorac Anesth. 2014;8(1):39–44.

    Article  Google Scholar 

  28. Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation. 2008;77(3):369–73.

    Article  PubMed  Google Scholar 

  29. Coté CJ, Petkau AJ, Ryan JF, Welch JP. Wasted ventilation measured in vitro with eight anesthetic circuits with and without in-line humidification. Anesthesiology. 1983;59(5):442–6.

    Article  PubMed  Google Scholar 

  30. Moutquin JM. Classification and heterogeneity of preterm birth. BJOG. 2003;110 Suppl 20:30–3.

    Article  PubMed  Google Scholar 

  31. Anand KJ, Sippell WG, Aynsley-Green A. Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. Lancet. 1987;1(8524):62–6.

    Article  CAS  PubMed  Google Scholar 

  32. Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23:876–82.

    Article  CAS  PubMed  Google Scholar 

  33. Hellström A, Smith LE, Dammann O. Retinopathy of prematurity. Lancet. 2013;382(9902):1445–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arundathi Reddy M.B., B.S. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Reddy, A., Bowe, E.A. (2018). Anesthesia Considerations in a Premie. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_49

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74766-8_49

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74765-1

  • Online ISBN: 978-3-319-74766-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics