Anesthesia for Neonatal Surgery

Neonatal anesthesia includes general anesthesia for term babies in the first month of life, as well as premature babies (babies born before the 37th week of pregnancy).

During surgery, anesthesiologists focus on preventing and treating:

  • Apnea (when breathing stops for 10 seconds or longer)
  • Meticulous fluid replacement
  • Managing blood loss
  • Monitoring and maintaining blood glucose levels
  • Controlling temperature
  • Managing pain

Hernia repair is a common procedure performed in newborns. We also do surgery for less common newborn conditions:

  • Tracheoesophageal fistula (an abnormal opening between the trachea and the esophagus)
  • Necrotizing enterocolitis (damage to the intestines)
  • Gastroschisis (an opening in the abdominal wall that allows the stomach and small and large intestines to protrude outside the body)
  • Omphalocele [a congenital (present at birth) malformation of the abdominal wall in which abdominal contents protrude into a thin-walled sac outside of the abdominal cavity]
  • Pyloric stenosis (narrowing of the lower portion of the stomach that leads to the small intestine)
  • Congenital diaphragmatic hernia (part of the abdomen protrudes through the diaphragm)

Before giving anesthesia, we will ask questions about your baby’s gestational age, birth history, history of apnea and lung disease and other problems of prematurity. We will evaluate the baby’s airway, heart and lung function, any congenital abnormalities and the state of hydration.

Before surgery, we may order laboratory tests including a blood count, kidney profile, calcium and glucose levels and clotting studies. We will review relevant imaging studies and consult with other physicians as needed.

General anesthesia is usually provided initially by intravenous (IV) or mask technique, followed by placement of the breathing tube.

Anesthesia professionals will monitor your child closely during surgery. For hernia surgery, routine equipment will check on the heart's electrical activity, blood pressure, oxygen levels in the blood, body temperature and breathing (measuring inhaled oxygen and exhaled carbon dioxide concentrations). For more major surgery, a special blood pressure monitor (an arterial line) may be used to continuously monitor blood pressure. An arterial line is like a regular IV, but placed in an artery rather than a vein. Similarly, a central line may be used to monitor central venous pressure.

Options for post-operative pain relief include IV narcotics and regional anesthesia such as a caudal block. For major surgery, we may use continuous nerve blocks. These blocks are placed once your child is asleep and controls pain during and after surgery.

To reduce the risk of apnea after surgery in premature babies, caffeine may be given by IV before anesthesia.

Healthy full-term babies older than 1 month of age may be able to have outpatient surgery.   Depending on their age, premature babies and some term babies (less than 1 month of age) are often admitted overnight for monitoring for apnea.

Newborns undergoing more extensive surgery are cared for in the Newborn Intensive Care Unit. The breathing tube may be kept in these babies for a period of time after surgery to assist ventilation. Pain control is provided by continuous nerve block or by IV pain medications.


Last Updated 05/2012