Anaesthesia in Preterm Infants:Hypoglycemia,Hyperglycemia,Fluid Administration

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Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital

Preterm infant :

Size: Anesthetic management of the preterm infant is complicated by the very small size of the patient.
Apneic Spell: Common in the preterm infant. Post-operative apnea monitoring should be ordered for all infants less than 48 weeks PCA. The risk of apnea is increased during the first 24 hours.
Temperature control: The preterm infant is extremely vulnerable to heat loss. His surface area is even larger than the body mass and he has no insulating subcutaneous tissue.
Oxygenation: This must be very carefully controlled if hypoxia is to be avoided and risk of retrolental fibroplasia minimized. Inspired oxygen must be kept to the minimum that will allow safe conduct of anesthesia.
- Ascertain the FiO2 required preoperatively to-achieve satisfactory oxygenation. During non-thoracic surgery with controlled ventilation, continue with this FiO2 and check blood gas levels frequently.
- Whenever there is no contraindication use an air/ FiO2 mixture to achieve the desired FiO2.
- During intra-thoracic surgery it is essential to increase FiO2, check the blood gas levels frequently and limit the oxygen concentration as far as possible while avoiding the possibility of inducing hypoxia.
Hypoglycemia and Hyperglycemia: Preterm infants are prone to hypoglycemia. Blood glucose levels of < 40 mg/dl should be corrected by infusions of glucose. Preterm infants are also prone to hyperglycemia, which leads to glycosuria, osmotic diuresis and dehydration and should be avoided by frequent blood sugar measurements.
Fluid administration: Avoid overload by careful control of I.V. Use tuberculin syringes to accurately measure small volumes of drugs. Syringe pumps and controlled lines are essential.
Coagulation: The preterm infant is subject to coagulopathy associated with shock and sepsis. Thrombocytopenia is common. Platelet concentrates, FFP or exchange transfusions may be required.

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