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Chapter 1 - Anatomical and Physiological Issues Affecting Anaesthesia in Neonates and Young Children

Published online by Cambridge University Press:  06 February 2025

By
Pratheeban Nambyiah
Edited by
James Ip ,
Grant Stuart ,
Isabeau Walker  and
Ian James
James Ip
Affiliation:
Great Ormond Street Hospital for Children, London
Grant Stuart
Affiliation:
Great Ormond Street Hospital for Children, London
Isabeau Walker
Affiliation:
Great Ormond Street Hospital for Children, London
Ian James
Affiliation:
Great Ormond Street Hospital for Children, London
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Summary

The neonatal period marks the transition from prenatal to postnatal life. This transition is characterised by rapid physiological change and neurodevelopmental plasticity. Anaesthesia, surgery and perioperative events have the potential to trigger long-lasting adverse outcomes. Understanding the changes that occur in the neonatal period is the key to delivering safe and effective care. In this chapter, we consider the development of major organ systems in utero, the transition from intrauterine to extrauterine life and aspects of newborn physiology relevant to the paediatric anaesthetist. We will also address the continuing debate regarding the potential for anaesthesia exposure in infancy to lead to persistent neurocognitive impairment.

Keywords

Infantnewborn physiologyneuronal plasticityanesthetics
Type
Chapter
Information
Core Topics in Paediatric Anaesthesia , pp. 1 - 12
Publisher: Cambridge University Press
Print publication year: 2025

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References

Further Reading

Baum, VC, Palmisano, BW. The immature heart and anesthesia. Anesthesiology 1997; 87(6):1529–48. doi:10.1097/00000542-199712000-00032CrossRefGoogle ScholarPubMed
Ikonomidou, C, Bosch, F, Miksa, M, et al. Blockade of NMDA receptors and apoptotic neurodegeneration in the developing brain. Science 1999; 283(5398):70–4. doi:10.1126/science.283.5398.70CrossRefGoogle ScholarPubMed
Murphy, PJ. The fetal circulation. Continuing Education in Anaesthesia Critical Care and Pain 2005; 5(4):107–12. doi:10.1093/bjaceaccp/mki030CrossRefGoogle Scholar
Neumann, RP, Ungern‐Sternberg, BS von. The neonatal lung: physiology and ventilation. Pediatric Anesthesia 2014; 24(1):10–21. doi:https://doi.org/10.1111/pan.12280CrossRefGoogle ScholarPubMed
Riviere, D, McKinlay, CJD, Bloomfield, FH. Adaptation for life after birth: a review of neonatal physiology. Anaesthesia and Intensive Care Medicine 2017; 18(2):59–67. doi:10.1016/j.mpaic.2016.11.008CrossRefGoogle Scholar
Walkden, G, Pickering, A, Gill, H. Assessing long-term neurodevelopmental outcome following general anesthesia in early childhood: challenges and opportunities. Anesthesia and Analgesia 2019; 128(4):681–94. doi:10.1213/ANE.0000000000004052CrossRefGoogle ScholarPubMed
Waspe, J, Chico, T, Hansen, T. Applying the adverse outcome pathway concept to questions in anaesthetic neurotoxicity. British Journal of Anaesthesia 2021; 126(3):1097–102.CrossRefGoogle ScholarPubMed

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