Preoperative cardiopulmonary evaluation in specific neonatal surgery
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In brief
In brief
This review examines cardiopulmonary evaluation strategies for surgical neonates, focusing on congenital diaphragmatic hernia management with echocardiography, screening for VACTERL associations in esophageal atresia and anorectal malformations, and managing bronchopulmonary dysplasia in ex-preterm infants. Emphasizes balancing surgical timing against anesthesia risks and postoperative apnea in all neonatal populations.
Written by the GCMD Library team from the article.
Publication date: Available online 18 January 2019
Source: Seminars in Pediatric Surgery
Author(s): Robin T. Petroze, Pramod S. Puligandla
Abstract
Preoperative assessment of surgical neonates often relates to issues of prematurity, low birth weight, or associated malformations. This review explores the preoperative cardiopulmonary evaluation in specific newborn surgical populations, the role of echocardiography in congenital diaphragmatic hernia perioperative management, the impact of bronchopulmonary dysplasia in the ex-preterm surgical neonate and a brief discussion on the risk of general anesthesia and specific anesthetic considerations for any surgical neonate.
Newborns with congenital anomalies requiring early general surgical intervention should have an assessment for congenital heart disease. In the asymptomatic neonate, a thorough physical exam may be sufficient preoperatively. Neonates born with esophageal atresia or anorectal malformations should have a full evaluation for VACTERL associations. Initial echocardiography in congenital diaphragmatic hernia is used to evaluate anatomy, but there is emerging evidence to suggest the use of echocardiography in the ongoing surveillance of CDH to influence the timing of surgical intervention. Bronchopulmonary dysplasia is present in up to 40% of ex-premature neonates and increases the risk of postoperative apneas and need for ventilatory support. However, all surgical neonates have an increased risk of post-operative apneas, and the need for surgical intervention should be balanced with the risk of general anesthesia.