Neonates and infants requiring anaesthesia are at risk of physiological instability
and complications, but triggers for peri-anaesthetic interventions and associations
with subsequent outcome are unknown.This prospective, observational study recruited
patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or
diagnostic procedures from 165 centres in 31 European countries between March 2016
and January 2017. The primary aim was to identify thresholds of pre-determined physiological
variables that triggered a medical intervention. The secondary aims were to evaluate
morbidities, mortality at 30 and 90 days, or both, and associations with critical
events.Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual
age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical
event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30%
decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age
influenced the incidence and thresholds for intervention. Risk of critical events
was increased by prior neonatal medical conditions, congenital anomalies, or both
(relative risk [RR]=1.16; 95% confidence interval [CI], 1.04-1.28) and in those requiring
preoperative intensive support (RR=1.27; 95% CI, 1.15-1.41). Additional complications
occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95%
CI, 2.7-3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia
was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64-7.71) and mortality
(RR=19.80; 95% CI, 5.87-66.7).Variability in physiological thresholds that triggered
an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight
the need for more standardised perioperative management guidelines for neonates and
infants.NCT02350348.
