Evaluation of Postoperative Apnea Incidence in Neonates Undergoing Minor Surgeries Under General Anaesthesia

Authors

  • Manoj S
  • Rosalyn Fiona Cyril
  • Ashiq Kalam

Keywords:

Neonates, Postoperative apnea, prematurity, anemia

Abstract

Background

Postoperative apnea is a significant concern in neonates undergoing surgery, especially in preterm infants and those with physiological immaturity. Minor surgical procedures performed under general anaesthesia can still pose a risk of respiratory complications in this vulnerable population. Early identification of risk factors can guide postoperative monitoring strategies and improve outcomes.

Aim:

To evaluate the incidence and characteristics of postoperative apnea in neonates undergoing minor surgeries under general anaesthesia and identify associated perioperative risk factors.

Methods

A prospective observational study was conducted on 70 neonates undergoing minor elective surgeries under general anaesthesia at a tertiary care teaching hospital. Neonates were monitored postoperatively for 12 hours. Data collected included gestational age, post-conceptional age, birth weight, hemoglobin levels, surgical details, and intraoperative events. The incidence, timing, and characteristics of apnea episodes were recorded. Associations between apnea and clinical variables were analyzed using chi-square test and logistic regression.

Results

Postoperative apnea occurred in 12 out of 70 neonates (17.1%), most commonly within the first 6 hours after surgery. Significant risk factors associated with apnea included prematurity (p = 0.001), anemia (p = 0.009), birth weight <2.5 kg (p = 0.002), and post-conceptional age <40 weeks (p < 0.001). Most apnea episodes were mild and responded to stimulation and supplemental oxygen; only 2 cases required CPAP.

Conclusion

Even minor surgeries under general anaesthesia can lead to postoperative apnea in neonates, particularly those who are preterm, anemic, of low birth weight, or have a younger post-conceptional age. Routine postoperative monitoring for at least 12 hours is recommended in at-risk neonates to ensure timely intervention and improve perioperative safety.

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References

Coté CJ. Postoperative apnea in former preterm infants: should we alter our current practices? Paediatr Anaesth. 1995;5(4):231–7.

Kurth CD, LeBard SE, Gregory GA. Apnea, bradycardia, and oxygen desaturation in the postoperative period in infants. Anesthesiology. 1987;66(4):483–6.

Butler MW, Kuhn MA, Borer JG. Neonatal surgery: a global perspective. Pediatr Surg Int. 2020;36(3):261–9.

Sodhi KS, Saxena AK, Khandelwal N. Neonatal surgery in India: challenges and the way forward. J Neonatal Surg. 2013;2(4):36.

Darnall RA. The role of CO2 and central chemoreception in the control of breathing in the fetus and the neonate. Respir Physiol Neurobiol. 2010;173(3):201–12.

Welborn LG, Rice LJ, Hannallah RS, Norden JM, Ruttimann UE, Bednarski RM. Postoperative apnea in preterm infants: prospective comparison of spinal and general anaesthesia. Anesthesiology. 1990;72(5):838–42.

Khatavkar SS, Bakhshi RG. Post-operative apnea in neonates and infants: a prospective observational study from a tertiary center in India. Indian J Anaesth. 2016;60(9):659–63.

Malviya S, Lerman J. The perioperative management of pediatric patients. Anesthesiol Clin North America. 2005;23(4):733–48.

Coté CJ, Davis PJ, Ward RM, Bahr BA, Vaccaro BJ, Todres ID. The effect of anaesthetic agents on the incidence of postoperative apnea in former premature infants. Anesthesiology. 1995;82(4):809–22.

Cummings JJ, Polin RA. Noninvasive respiratory support. Clin Perinatol. 2016;43(3):551–65.

Darnall RA. The role of CO₂ and central chemoreception in the control of breathing in the fetus and the neonate. Respir Physiol Neurobiol. 2010;173(3):201–12.

Malhotra S, Savoldelli GL, Brochard L. Management of postoperative apnea in neonates and infants. Curr Opin Anaesthesiol. 2011;24(3):300–5.

Lin Y, Liu C, Wang Z, Chen J. Risk factors of postoperative apnea in premature infants after general anaesthesia. BMC Anesthesiol. 2019;19:212.

Vali P, Lakshminrusimha S. The fetus can teach us: oxygen and the circulation of the fetus and neonate. NeoReviews. 2017;18(6):e357–67.

Williams RK, Adams DC, Aladjem EV, Kreutz JM, Sartorelli KH, Vane DW. The safety and efficacy of spinal anaesthesia for surgery in infants: the Vermont Infant Spinal Registry. Anesth Analg. 2006;102(1):67–71.

Astuto M, Disma N, Crimi E, Rosano G, Raciti L, Sciuto O, et al. General anaesthesia vs caudal anaesthesia in neonates and infants undergoing inguinal herniorrhaphy: a randomized multicenter trial. Paediatr Anaesth. 2020;30(2):144–51.

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Published

2025-05-10

How to Cite

1.
S M, Fiona Cyril R, Kalam A. Evaluation of Postoperative Apnea Incidence in Neonates Undergoing Minor Surgeries Under General Anaesthesia. J Neonatal Surg [Internet]. 2025May10 [cited 2025Sep.11];14(18S):1044-9. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/5521

Issue

Vol. 14 No. 18S (2025): Journal of Neonatal Surgery

Section

Original Article

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