Characterization of neonatal anesthesia in Colombia from a multidisciplinary perspective. Observational study

Introduction: The neonatal period, encompassing the first 28 days of life, is marked by low functional reserve and adaptation to extrauterine life. Neonates have higher postoperative morbidity and mortality compared to older pediatric patients. The anesthesiologist’s expertise significantly influences neonatal perioperative outcomes. In Colombia, disparities in healthcare access and education impact neonatal anesthesia training. However, there is limited information on neonatal anesthesia practice and training in the country. Objective: To characterize neonatal anesthesia from the perspective of anesthesiologists, pediatric surgeons, neonatologists, and directors of specialization programs in anesthesiology in Colombia. Methods: An observational, cross-sectional study was conducted. A survey was administered among practicing anesthesiologists, pediatric surgeons, neonatologists, and directors of anesthesiology programs in Colombia with regards to several aspects of neonatal anesthesia. An ad hoc questionnaire was designed including 5 domains: perception of professional practice, techniques used, technical and logistical resources of the institutions, training received during the anesthesiology residency, and curricular aspects of the anesthesiology postgraduate program in Colombia. Results: According to the neonatologists, the anesthesia categories with the worst performance were thermoregulation (poorly managed 38.8% and very poorly managed 22.4%) and management of intravenous fluids (poorly managed 34.7% and very poorly managed 6.1%). With regards to the opinion of the pediatric surgeons, the categories with the lowest performance were thermoregulation (poorly managed 12.5%) and the use of vasoactive medications (poorly managed: 6.3% and very poorly managed 3.1%). 77.8% of the country's anesthesiology programs fail to include neonatal anesthesia as part of the syllabus. 61.5% of anesthesiologists considered their training inadequate to manage a surgical neonate and 89.6% believe that pediatric anesthesia should be a subspecialty in Colombia. Conclusions: There is a discrepancy between anesthesiologists' self-perception of neonatal care and the views of neonatologists and pediatric surgeons. In Colombia, academic training in neonatal anesthesiology appears to be limited, reflecting gaps in the curricular content of training programs.