title: Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair.
abstract: OBJECTIVE
  To investigate the risk factors and incidence of perioperative adverse effects from unsupplemented spinal anesthesia in preterm infants. Times to resumption of oral feeding and to home discharge were also evaluated.
  
  
  METHODS
  Perioperative data were collected prospectively for all preterm and former preterm infants who underwent inguinal hernia repair with spinal anesthesia at a tertiary medical center.
  
  
  RESULTS
  The study group consisted of 144 infants with a median gestational age of 30 weeks, postmenstrual age of 37 weeks, birth weight of 1,420 g, and weight at surgery of 2,140 g. Overall, six (4.2%) infants had intraoperative complications, which included apnea (2/1.4%), bradycardia (2/1.4%), and hypoxemia (4/2.8%). Postoperative complications occurred in 15 (10.4%) infants, mainly hypoxemia (3/2.1%), bradycardia (8/5.5%), and apnea (6/4.1%). Predictive factors of an unfavorable outcome (apnea, resumption of oral feeding > 6 h postoperatively, or discharge > 30 h postoperatively) were bronchopulmonary dysplasia (odds ratio [OR] = 3.2, 95% confidence interval [95%CI] 2.8-5.3; p = 0.01) and periventricular leukomalacia (OR = 2.8, 95%CI 2.1-4.9; p = 0.03).
  
  
  CONCLUSIONS
  Spinal anesthesia is safe and effective for inguinal hernia repair in preterm infants, with early resumption of oral feeding and short hospitalization. Bronchopulmonary dysplasia and periventricular leukomalacia may pose risks for an unfavorable outcome.
authors.affiliation: Department of Anesthesia, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ze'ev
authors.initials: Z
authors.lastname: Shenkman
authors.forename: Ilan
authors.initials: I
authors.lastname: Erez
authors.forename: Enrique
authors.initials: E
authors.lastname: Freud
authors.forename: Shmuel
authors.initials: S
authors.lastname: Arnon
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000706:statistics & numerical data; D001049:Apnea / Q000209:etiology; D001919:Bradycardia / Q000209:etiology; D005260:Female; D005865:Gestational Age; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors