Perioperative anesthetic considerations and practical management framework for neonates with aplasia cutis congenita: a two-patient case series

Aplasia cutis congenita (ACC) is a rare congenital anomaly characterized by absence of skin and in some cases, underlying bone in the newborn. Although ACC is well described in the plastic surgery and neurosurgery literature, anesthesiology-focused reports remain limited. As a result, practical guidance addressing perioperative anesthetic management in these physiologically vulnerable infants is lacking. We present two neonates with severe aplasia cutis congenita requiring urgent surgical intervention within the first few days of life. We contrast the two presentations of ACC, one with isolated disease and the other presenting as part of a syndrome with associated congenital heart disease. These cases illustrate key perioperative considerations, including airway management, risk of significant blood loss, and the need for careful positioning. They also demonstrate how comorbid conditions may influence anesthetic planning and intraoperative management. Perioperative management of neonates with ACC requires meticulous preoperative assessment, anticipation of significant blood loss, and coordinated multidisciplinary care. This case series proposes a structured perioperative anesthetic framework for neonates with ACC that may facilitate standardized care in this high-risk population.