Anaesthesia for the prematurely born infant

Although the number of babies born prematurely remains small, they require a great deal of care, both acutely and in the long term. In recent years the survival of the most premature has improved. However, many go on to develop medical problems as a result of their prematurity. It is now well recognized that preterm infants are at increased risk of developing postoperative respiratory complications, apnoea being the most serious. The incidence of apnoea is inversely related to gestational age at birth and postconceptual age, and occurs more commonly in anaemic infants. The use of spinal anaesthesia or the methylxanthines may reduce the incidence of this complication. Preterm infants who are less than 60 weeks postconceptual age should only have operations carried out as inpatients. They must be carefully observed following surgery, especially for respiratory complications. The age at which preterm infants outgrow this risk is still ill-defined and must be considered on an individual basis.