After nectarine: how should we provide anesthesia for neonates?


This review summarised findings from NECTARINE (NEonate and Children audiT of Anaesthesia pRactice IN Europe) including its limitations. Subsequently, deductions from the findings of NECTARINE were used to review relevant literature to suggest how practice and care of neonates and infants could be optimised from an individual practitioner to institutional level.

Some of the take home points include:

  • Interestingly hypotension (50%) rather than hypoxaemia (36%) was the most common intraoperative critical event.
  • Risk factors for critical events included younger age, pre-existing medical conditions, preoperative intensive support and prolonged surgery. However, low body weight was not.
  • Difficult tracheal intubation was not uncommon but only 1/3 were anticipated to be difficult. Therefore, treating all children <60 weeks post menstrual age as difficult may be a more appropriate approach.
  • The triad of hypotension, hypoxia and anaemia increased risk of morbidity and mortality by 20-fold.
  • Standard heart rate and blood pressure parameters used as a surrogate marker of tissue perfusion is inadequate. The concept of using NIRS to approximate oxygen delivery in high-risk patients was raised.

Take home message

Neonates and infants are at high risk of critical events leading to potential morbidity and mortality. Recognition of these patients and transfer of care to trained paediatric practitioners and specialised paediatric units may help mitigate some of these complications. None the less, evidence on optimal management is deficient in this realm.  

Reviewed by Dr Sorcha Evans