Bonfiglio Rachele, Francavilla Andrea, Gregori Dario, Lenares Elena, Kuppers Beate, Mondarini Maria C, Camporesi Anna, Sbaraglia Fabio, Disma Nicola
Unit for Research in Anesthesia, Department of Pediatric Anesthesia, IRCCS Giannina Gaslini Institute, Genoa, Italy -
Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padua, Italy.
Minerva Pediatr (Torino). 2023 May 8. doi: 10.23736/S2724-5276.23.07139-2.
Recent literature on neonatal anesthesia focuses on the importance of keeping physiology within the ranges of normality to improve the long-term neurological outcome. The Neonate and Children audit of Anesthesia pRactice IN Europe (NECTARINE) showed a derangement of one or more than one physiological parameters during anesthesia needing a medical intervention in 35.2% of 6592 anesthesia procedure performed in infants up to 60 weeks postmenstrual age.
Subanalysis of the Italian NECTARINE cohort providing a snapshot of anesthesia management, incidence of clinical events requiring intervention during anesthesia, and morbidity and mortality at 30 and 90 days. Secondary aim was to compare outcomes between Italy and Europe.
Twenty-three Italian centers recruited 501 patients (63% male, 37% female) undergoing 611 procedures (441 surgical and 170 non-surgical) with a mean gestational age at birth of 38 weeks. Events requiring a medical intervention during anesthesia occurred in 177 cases (28.9%), lower than those reported in Europe (35.3%). The majority of events concerned episodes of cardiovascular instability, most commonly due to hypotension. The incidence of mortality at 30 days was 2.7%, consistent with the European incidence.
Anesthetizing neonates is challenging. It is crucial that neonatal anesthesia practice is performed in specialized centers to maximize the potential positive outcome. We recommend a certification of quality for Institutions providing care for very young patients.
近期关于新生儿麻醉的文献聚焦于将生理指标维持在正常范围内对于改善长期神经学预后的重要性。欧洲新生儿与儿童麻醉实践审计（NECTARINE）显示，在对6592例孕龄达60周的婴儿实施的麻醉过程中，35.2%的麻醉操作出现了一个或多个需要医学干预的生理参数紊乱情况。
对意大利NECTARINE队列进行亚分析，以提供麻醉管理的概况、麻醉期间需要干预的临床事件发生率以及30天和90天时的发病率和死亡率。次要目的是比较意大利和欧洲之间的结果。
23个意大利中心招募了501例患者（63%为男性，37%为女性），接受了611例手术（441例外科手术和170例非外科手术），出生时平均胎龄为38周。麻醉期间需要医学干预的事件发生在177例（28.9%），低于欧洲报告的发生率（35.3%）。大多数事件涉及心血管不稳定情况，最常见的原因是低血压。30天时的死亡率为2.7%，与欧洲的发生率一致。
为新生儿实施麻醉具有挑战性。至关重要的是，新生儿麻醉实践应在专业中心进行，以最大限度地提高潜在的积极结果。我们建议为为极年幼患者提供护理的机构颁发质量认证。
