Neonates..CNS..and Anesthesia

Intraventricular haemorrhage occurs in 25% of very low birth weight infants, mostly within the first 72 hours of life. Intraventricular haemorrhage may be complicated by ventricular dilation, which can progress to hydrocephalus, parenchymal infarction, or cystic periventricular matter injury.

 The risk factors include RDS, hypotension, aggressive fluid resuscitation, fluctuating blood pressure and hypertonic infusions. Periventricular leucomalacia describes changes in white matter associated with hypoxia, hypotension, severe hypocarbia, large PDA, toxic injury or infection. It is a strong predictor for later cerebral palsy.

Research has shown pain receptors develop by 20 weeks GA and pain pathways develop by 26 weeks. A foetus of 26 weeks may demonstrate a stress response in response to stimulation.

 There has been recent concern about that anaesthetic agents may have an effect on the developing brain leading to later memory and learning impairment. Only essential surgery should be performed in early life, and ketamine should probably be avoided in premature babies.