Post-operative apnoea in the former preterm infant: a review

Summary Former preterm infants are known to be at increased risk for apnoea, periodic breathing, and bradycardia. When surgery cannot be postponed until respiratory function is more mature, speical peri-operative considerations and measures are essential. In this article, the literature concerning this subject is reviewed, summarizing prospective and retrospective studies of risks associated with surgery in former preterm infants during the first year of life. This work is placed within the context of our ongoing studies of peri-operative risk in former preterm infants undergoing surgery at the Children's National Medical Center (CNMC), which have focused on three particular areas: (1) the effects of spinal versus general anaesthesia on the incidence of post-operative apnoea and bradycardia; (2) the possible contribution of anaemia of prematurity to surgical risk; and (3) the effect of peri-operative caffeine in preventing post-operative apnoea. Recommendations are made concerning surgical and anaesthetic management of infants who undergo surgery at < 44 weeks' post-conceptual age.