TY - JOUR
T1 - Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)
AU - NECTARINE Group of the European Society of Anaesthesiology Clinical Trial Network
AU - Austria
AU - Belgium
AU - Czech Republic
AU - Denmark
AU - Estonia
AU - Finland
AU - France
AU - Germany
AU - Greece
AU - Hungary
AU - Ireland
AU - Italy
AU - Latvia
AU - Lithuania
AU - Luxembourg
AU - Malta
AU - Netherlands
AU - Norway
AU - Poland
AU - Portugal
AU - Romania
AU - Serbia
AU - Slovakia
AU - Slovenia
AU - Spain
AU - Switzerland
AU - Turkey
AU - Ukraine
AU - Disma, Nicola
AU - Veyckemans, Francis
AU - Virag, Katalin
AU - Hansen, Tom G.
AU - Becke, Karin
AU - Harlet, Pierre
AU - Vutskits, Laszlo
AU - Walker, Suellen M.
AU - de Graaff, Jurgen C.
AU - Croatia
AU - Zielinska, Marzena
AU - Simic, Dusica
AU - Engelhardt, Thomas
AU - Habre, Walid
AU - Breschan, Christian
AU - Likar, Rudolf
AU - Platzer, Manuela
AU - Edelman, Isole
AU - Eger, Johanes
AU - Heschl, Stefan
AU - Messerer, Brigitte
AU - Vittinghof, Maria
AU - Kroess, Ruth
AU - Stichlberger, Martina
AU - Kahn, David
AU - Pirotte, Thierry
AU - Pregardien, Caroline
AU - Stevens, France
AU - Berghmans, Johan
AU - Bauters, Annemie
AU - de Baerdemaeker, Luc
AU - de Hert, Stefan
AU - Lapage, Koen
AU - Parashchanka, Aliaksandra
AU - van Limmen, Jurgen
AU - Wyffels, Piet
AU - Lauweryns, Julie
AU - Najafi, Nadia
AU - Vundelinckx, Joris
AU - Butković, Diana
AU - Sorić, Ivana Kerovec
AU - Kralik, Sandra
AU - Markić, Ana
AU - Azman, Josip
AU - Markic, Josko
AU - Pupacic, Daniela
AU - Frelich, Michal
AU - Reimer, Petr
AU - Urbanec, Rene
AU - United Kingdom
AU - Emal, Dina
AU - Stevens, Markus
N1 - Funding Information: European Society of Anaesthesiology and Intensive Care - Clinical Trial Network (ESAIC-CTN); Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) funded the study for the follow-up of patients enrolled in the UK. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO 2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348.
AB - Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO 2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348.
KW - critical events
KW - neonates
KW - outcome
KW - patient safety
KW - quality
UR - http://www.scopus.com/inward/record.url?scp=85106554104&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.bja.2021.02.016
DO - https://doi.org/10.1016/j.bja.2021.02.016
M3 - Article
C2 - 33812668
SN - 0007-0912
VL - 126
SP - 1157
EP - 1172
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 6
ER -