Key result
Unexpected intraoperative instability shows no significant link to 30-day postoperative neurological complications.
Why the study?
Neonates and infants are vulnerable to postoperative neurological complications after procedures requiring general anaesthesia, but the association with intra-operative physiologic instability interventions is unclear.
Does intervention for unexpected intra-operative physiologic instability increase the risk of postoperative neurological complications in neonates and infants?
Cohort (n=5,504)
Yes
Does intervention for unexpected intra-operative physiologic instability increase the risk of postoperative neurological complications in neonates and infants?
In neonates and infants undergoing anesthesia, requiring intra-operative interventions for physiological instability was not significantly associated with an increased risk of 30-day postoperative neurological complications, despite an overall higher baseline complication rate (2.5%) compared to adult noncardiac surgery.
Should not yet change intraoperative management in neonates; hypothesis-generating for instability's role in neurological outcomes.
BACKGROUND: Neonates and infants are among the most vulnerable populations to undergo procedures necessitating general anaesthesia and are at risk for postoperative neurological complications. The objective of this study was to assess the association between interventions for intra-operative physiologic instability and the development of postoperative neurological complications in a cohort of neonates and infants undergoing operative and nonoperative procedures. METHODS: Data for this study were extracted from the NECTARINE study: a prospectively collected cohort of neonates and infants receiving anaesthesia for operative and nonoperative procedures from 165 participating hospitals in 31 countries.In a multivariable logistic regression model predicting the development of a neurologic complication up to 30 days postoperatively, exposures of interest were binary indicators of unexpected intra-operative instability of systemic homeostasis necessitating a corrective action (based on blood pressure, heart rate, end-tidal and/or blood CO 2 , glucose and sodium). RESULTS: One hundred and forty out of 5504 (2.5%) neonates and infants developed a postoperative neurologic complication. No statistically significant association was found between interventions for intra-operative physiologic instability and the development of a postoperative neurologic complication. CONCLUSION: In this secondary analysis of neonates and infants undergoing cardiac and noncardiac procedures, we found a higher rate of neurologic complications compared to adult populations undergoing noncardiac surgery. There was no association between unexpected intra-operative instability of systemic homeostasis necessitating a corrective action and subsequent neurologic complications; however, these findings do not necessarily indicate the absence of any effect of physiological disturbances on neurologic outcomes.
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Tangel et al. (2025) conducted a cohort in Postoperative neurological complications in neonates and infants (n=5,504). Unexpected intra-operative instability of systemic homeostasis necessitating a corrective action (e.g., hypotension) vs. No unexpected intra-operative instability requiring intervention was evaluated on Development of any neurological complication up to 30 days postoperatively (aOR 1.33, 95% CI 0.89 to 1.99, p=0.791). Unexpected intra-operative instability requiring corrective action, such as for hypotension, was not significantly associated with the development of postoperative neurological complications at 30 days.
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