Incidence and risk factors for intraoperative hypotension in neonates undergoing non-cardiac surgery: a retrospective cohort study.

OBJECTIVE: Intraoperative hypotension is associated with adverse postoperative outcomes, yet evidence in the neonatal population is limited. This study aimed to investigate the incidence, risk factors, and prognostic significance of intraoperative hypotension in this population. METHODS: This single-center retrospective study included 1712 neonates undergoing non-cardiac surgery from 2020 to 2025 at a tertiary children's hospital in China. Intraoperative hypotension was defined as a reduction in mean arterial pressure of more than 20% from the preoperative baseline and lasting for more than 5 min. Multivariate logistic regression identified independent risk factors. RESULTS: The incidence of intraoperative hypotension was 59.8% (1024/1712). Independent risk factors included American Society of Anesthesiologists Physical Status Classification > Ⅲ (OR = 1.357, 95% CI: 1.079-1.706, P = 0.009), emergency surgery (OR = 1.323, 95% CI: 1.054-1.660, P = 0.016), surgery duration > 60 min (OR = 1.457, 95% CI: 1.162-1.826, P = 0.001), thoracic surgery (OR = 1.727, 95% CI: 1.053-2.831, P = 0.030), preoperative congenital heart disease (OR = 1.379, 95% CI: 1.117-1.702, P = 0.003), and preoperative acidosis (OR = 1.349, 95% CI: 1.036-1.757, P = 0.026). Higher gestational age (OR = 0.936, 95% CI: 0.891-0.983, P = 0.008) and neurosurgery (OR = 0.566, 95% CI: 0.385-0.832, P = 0.004) were protective factors. Intraoperative hypotension was associated with prolonged postoperative recovery and increased acute kidney injury and intraventricular hemorrhage (all P < 0.05). CONCLUSIONS: Intraoperative hypotension is highly prevalent in neonatal non-cardiac surgery and was associated with short-term outcomes. Identified risk and protective factors may guide perioperative hemodynamic optimization in this vulnerable population.