ORIGINAL ARTICLE   

Minerva Pediatrics 2023 May 08

DOI: 10.23736/S2724-5276.23.07139-2

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Morbidity and mortality after anesthesia in early life in Italy. A subgroup analysis of the NECTARINE Trial

Rachele BONFIGLIO ¹ ✉, Andrea FRANCAVILLA ², Dario GREGORI ², Elena LENARES ³, Beate KUPPERS ⁴, Maria C. MONDARINI ⁵, Anna CAMPORESI ⁶, Fabio SBARAGLIA ⁷, Nicola DISMA ¹ IT NECTARINE group 

¹ Unit for Research in Anesthesia, Department of Pediatric Anesthesia, IRCCS Giannina Gaslini Institute, Genoa, Italy; ² Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padua, Italy; ³ AOU A. Meyer, Florence, Italy; ⁴ Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy; ⁵ A.O.U. S. Orsola Malpighi Polyclinic, Bologna, Italy; ⁶ Vittore Buzzi Children Hospital, Milan, Italy; ⁷ IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.

KEY WORDS: Anesthesia; Adverse effects; Mortality