Cerebral monitoring during neonatal surgery for non-cardiac congenital anomalies: a first step to improve outcome?

Abstract

Monitoring the newborn brain during surgery Cerebral monitoring in newborns, who require surgery in the first month of life, is important to protect the brain. The newborn brain is vulnerable during neonatal surgery. Newborn babies with a congenital anomaly requiring surgery in the first month of life, are at risk of neurodevelopmental delay. A systematic literature study confirmed this finding by Stolwijk et al. Therefore, since 2013 the Wilhelmina Childrens Hospital has started with cerebral monitoring during surgery and a postoperative MRI of the brain. Stolwijk et al found a high incidence of postoperative brain injury of 63% in patients with non-cardiac congenital anomalies. Also, they discovered that intact cerebral autoregulation of the perfusion in term neonates disappeared during general anaesthesia. This was studied by measuring the oxygen saturation of the brain (Near Infrared Spectroscopy). A small range in the dose of anaesthesia dose caused a wide variety in depression of the brain activity, monitored by amplitude-integrated EEG. Stolwijk et al discovered that neuromonitoring assists in minimalizing the effect of carbon dioxide during laparoscopic and thoracoscopic procedures on the cerebral perfusion by adjusting ventilation settings. Neuromonitoring helps to identify factors influencing the brain perfusion and activity. It offers the opportunity to keep these factors within normal limits. Next to neuromonitoring, is close collaboration between the anesthesiologist, the paediatric surgeon and the neonatologist crucial to achieve this.