Intraoperative hypotension in neonates: when and how should we intervene?

Organ hypoperfusion remains an important cause of postoperative morbidity in neonates. Blood pressure (BP) is frequently mistakenly used as a surrogate of organ perfusion and the predictive value of BP for outcome is unclear. The current article will focus on the role of BP in the optimization of organ perfusion during anaesthesia in neonates.

Population studies show a range of normal values for BP in neonates and there is no consensus on the definition of hypotension in neonates undergoing anaesthesia. The relationship between BP and outcome is unclear. Unnecessary treatment of low BP in neonates can be harmful. A theoretical approach to the definition of hypotension and increasing knowledge of neonatal cardiovascular pathophysiology can give insights to improve anaesthetic management. Near-infrared spectroscopy as a measure of organ perfusion can help to determine the need for treatment.

Anaesthetic management should focus on optimizing organ perfusion and not merely on maintaining a particular BP. A collaborative approach is recommended. The carbon dioxide tension is crucial to perfusion in the presence of cardiovascular shunts.