Special considerations in the premature and ex-premature infant

Advances in neonatal medicine have progressively increased the survival of premature infants. Increased survival has, however, come at the cost of increased number of infants with prematurity related complications. This is represented by high rates of respiratory distress syndrome, bronchopulmonary dysplasia, necrotising enterocolitis, sepsis, periventricular leukomalacia, intraventricular haemorrhage, cerebral palsy, hypoxic ischaemic encephalopathy and visual and hearing problems in survivors. In addition to prolonged hospital stay after birth, readmission to hospital in the first year of life is common if chronic lung disease exists. Individual congenital conditions requiring surgical intervention in the neonatal period are uncommon. Neonates have a higher perioperative mortality risk largely due to the degree of prior illness, the complexity of their surgeries and infant physiology. It is important to consider contributing anaesthetic factors during the perioperative period that may affect cerebral perfusion and neurocognitive outcome, such as alterations in haemodynamics and ventilation. Outside of the neonatal period, the most common surgical procedures performed in ex-premature infants are inguinal hernia repair and ophthalmologic procedures due to retinopathy of prematurity. After even minor surgical procedures, ex-premature infants are at higher risk for postoperative complications than infants born at term.