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Neonatal Anesthesia

Neonatal Anesthesia

As with all patients, when a young or premature infant needs surgery or a medical procedure, safe and effective anesthesia is a major concern. Anesthesia is administered to even the youngest babies, including neonates (infants who are 28 days old or younger) and premature babies (infants who are born before their due date). Evidence shows that these babies do react to pain and can greatly benefit from anesthesia during surgery or other painful or stressful procedures.

Anesthesia may be required when a premature infant or a neonate undergoes a surgical procedure early in life to treat a condition such as:

  • A congenital heart defect or other cardiac condition
  • A neurological condition such as a brain or spinal cord defect
  • An airway obstruction or defect that can interfere with breathing
  • An abdominal or intestinal condition

Because many of these conditions are life-threatening, prompt repair or treatment is critical. Surgery and other medical procedures on infants may be performed in an emergency situation, including some that occur immediately or shortly after birth. Pediatric anesthesiologists work closely with surgeons, obstetricians, neonatologists and other professionals to ensure all services are in place whenever an infant needs surgery or treatment requiring anesthesia. Anesthetic management of the premature infant and the neonate is an important aspect of the practice of pediatric anesthesiologists.

What to Expect

Before your baby undergoes surgery or another medical procedure requiring anesthesia, the pediatric anesthesiologist will:

  • Review your baby’s medical history, including gestational age (the length of time since your baby was conceived)
  • Ask questions about your baby’s health, past surgical and anesthetic experiences and your family’s anesthesia history
  • Perform a physical exam, including possible lab work to check for specific issues that should be considered during surgery or anesthesia
  • Meet with your family, if time allows, to discuss the anesthesia plan which most often will be a general anesthetic for premature infants and neonates
  • Talk to you about the benefits of anesthesia for your baby as well as the associated risks and how he or she will help keep your baby safe during the procedure

You can expect the following during your baby's surgery:

  • A nurse will take your baby to the operating room. In most cases, your baby will either breathe in medicine through a special mask and go to sleep right away or receive medicine through an intravenous (IV) line to go to sleep. Once he or she is asleep, the pediatric anesthesiologist will usually insert a breathing tube to help your baby’s breathing during surgery.
  • The anesthesiologist will monitor your baby closely throughout the surgery or procedure to ensure proper breathing and to make sure he or she is safely and soundly asleep. Special equipment will monitor your baby’s vital signs including blood pressure, temperature, oxygen level and the heart’s electrical activity.
  • After the surgery, the anesthesiologist will stop administering medicine so your baby will begin to wake up. He or she may remain asleep or nearly asleep for a few minutes to a few hours, depending on his or her condition and the type of surgical procedure. Some premature babies need help with their breathing for a while after surgery. If your baby needs breathing help, sedating medicines will be administered following surgery to help keep your baby comfortable. He or she will be closely monitored during this time.
  • You and your child will be reunited as soon as it is safe.

Your baby will need to remain at the hospital at least overnight so his or her medical team can keep watch for any problems or complications. He or she will stay in one of several of the hospital’s patient care units. The neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) cares for babies who have had major surgery or who need advanced care, including mechanical ventilation.

Key Points to Remember

  • Anesthesia for neonates and premature infants is used during surgery or treatment for congenital conditions or other conditions that need to be treated soon after birth.
  • A pediatric anesthesiologist monitors your baby and the course of your baby’s anesthetic throughout surgery and into the recovery period.
  • Following surgery, your baby will need to remain at the hospital at least overnight for monitoring.

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