4.1 Article

Perioperative critical events and morbidity associated with anesthesia in early life: Subgroup analysis of United Kingdom participation in the NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) prospective multicenter observational study

期刊

PEDIATRIC ANESTHESIA
卷 32, 期 7, 页码 801-814

出版社

WILEY
DOI: 10.1111/pan.14457

关键词

anesthesia; adverse effects; anesthesia; mortality; infant; newborn; patient-relevant outcome

资金

  1. European Society of Anaesthesiology and Intensive Care - Clinical Trial Network (ESAIC-CTN)
  2. Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) via the National Institute of Academic Anaesthesia [WKRO-2015-0059]
  3. National Institute for Health Research (NIHR) Clinical Trial Network (UKCRN) [20748]

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The NECTARINE study found that perioperative critical events and co-morbidities are common in neonates and young infants. There were no significant differences in 30-day morbidity and mortality between UK and nonUK participants. Identifying factors associated with increased risk is crucial for preoperative assessment and discussions.
Background The NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) prospective observational study reported critical events requiring intervention during 35.2% of 6542 anesthetic episodes in 5609 infants up to 60 weeks postmenstrual age. The United Kingdom (UK) was one of 31 participating countries. Methods Subgroup analysis of UK NECTARINE cases (12.8% of cohort) to identify perioperative critical events that triggered medical interventions. Secondary aims were to describe UK practice, identify factors more commonly associated with critical events, and compare 30-day morbidity and mortality between participating UK and nonUK centers. Results Seventeen UK centers recruited 722 patients (68.7% male, 36.1% born preterm, and 48.1% congenital anomalies) undergoing anesthesia for 876 surgical or diagnostic procedures at 25-60 weeks postmenstrual age. Repeat anesthesia/surgery was common: 17.6% patients prior to and 14.4% during the recruitment period. Perioperative critical events triggered interventions in 300/876 (34.3%) cases. Cardiovascular instability (16.9% of cases) and/or reduced oxygenation (11.4%) were more common in younger patients and those with co-morbidities or requiring preoperative intensive support. A higher proportion of UK than nonUK cases were graded as ASA-Physical Status scores >2 or requiring urgent or emergency procedures, and 39% required postoperative intensive care. Thirty-day morbidity (complications in 17.2%) and mortality (8/715, 1.1%) did not differ from nonUK participants. Conclusions Perioperative critical events and co-morbidities are common in neonates and young infants. Thirty-day morbidity and mortality data did not demonstrate national differences in outcome. Identifying factors associated with increased risk informs preoperative assessment, resource allocation, and discussions between clinicians and families.

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