Postanesthesia Apnea in Former Preterm and Term Infants: A Qualitative Systematic Review and Meta-analysis.

Area of Science:

• Pediatric Anesthesiology
• Neonatal Medicine
• Evidence-Based Medicine

Background:

• Former preterm and term infants face risks of postanesthesia apnea.
• Inconsistent monitoring and discharge standards contribute to variable clinical practices.
• Identifying major risk factors is crucial for improving infant safety post-anesthesia.

Purpose of the Study:

• To systematically review and meta-analyze risk factors for postanesthesia apnea in infants.
• To identify key predictors influencing the incidence of postanesthesia apnea.

Main Methods:

• Systematic review and meta-regression analysis following PRISMA and AHRQ guidelines.
• Literature search of multiple databases from inception to October 2025.
• Inclusion of 115 articles (98 studies, 17 case reports/series) for data extraction and analysis.

Main Results:

• Median apnea incidence was 7.6% across studies.
• Significant predictors identified: gestational age, postmenstrual age, birth weight, procedure duration, and publication year.
• Decreased apnea odds correlated with later publication year, older gestational/postmenstrual age, higher birth weight, and shorter procedure duration.
• Neuraxial anesthesia showed significantly lower apnea odds compared to general anesthesia.

Conclusions:

• Postmenstrual age is the most significant and consistent risk factor for postanesthesia apnea.
• Neuraxial anesthesia may offer a protective effect against postanesthesia apnea.
• Further research, including individual participant data meta-analysis, is needed to refine monitoring guidelines.