Perioperative Management of the Neonatal Patient

Over the past several decades, advances in prenatal evaluation, neonatal care, diagnostic techniques, anesthesia, and clinical management have enhanced care of pediatric surgical patients. Neonates have their own physiologic characteristics that must govern their care. The most distinctive and rapidly changing functions occur during the neonatal period. This is due to the newborn infant’s adaptation from complete placental support to the extrauterine environment, differences in physiologic maturity of individual neonates, small size of these patients, and demands of growth and development.1 Advances in neonatal care have resulted in survival of increasing numbers of extremely low birth weight infants. However, pediatric surgeons and neonatologists are now faced with more complex diseases due to extreme prematurity. Derangements in temperature regulation, fluid and electrolyte homeo stasis, glucose metabolism, hematologic indices, and immune function are magnified in this setting. Preterm infants are more vulnerable to specific problems such as intraventricular hemorrhage, hyaline membrane