• clinical efficacy
• modified bubble CPAP
• neonatal respiratory distress
• resource-limited settings
• respiratory support

• Bronchiolitis
• High Flow Nasal Cannula therapy
• Non-invasive ventilation
• Outcomes

• Humans
• Oxygen Inhalation Therapy/methods
• Oxygen Inhalation Therapy/instrumentation
• Bronchiolitis/therapy
• Continuous Positive Airway Pressure/methods
• Cannula
• Treatment Outcome
• Infant

• electrical impedance tomography (EIT)
• general anaesthesia
• infant
• mechanical ventilation
• neonate
• regional ventilation

• ELGANS
• less invasive surfactant administration (LISA)
• minimal invasive surfactant therapy (MIST)
• respiratory distress syndrome
• respiratory physiology

• Nasal CPAP
• Newborn
• Nursing
• Pain
• Stress
• White noise

• Humans
• Infant, Newborn
• Continuous Positive Airway Pressure/methods
• Crying
• Female
• Male
• Noise/adverse effects
• Pain Measurement
• Pain/prevention & control
• Pain/etiology
• Stress, Psychological/prevention & control
• Pain Management/methods

• adverse events
• anesthesia
• children
• outcomes
• pediatric
• perioperative
• positioning

• Humans
• Child
• Patient Positioning/methods
• Perioperative Care/methods

• Stan Perron Charitable Foundation
• National Health and Medical Research Council

• humans
• infant, newborn
• bias
• high-frequency ventilation
• high-frequency ventilation/methods
• infant, premature
• intubation, intratracheal
• intubation, intratracheal/methods
• noninvasive ventilation
• noninvasive ventilation/methods
• pulmonary surfactants
• pulmonary surfactants/therapeutic use
• randomized controlled trials as topic
• respiratory distress syndrome, newborn
• respiratory distress syndrome, newborn/mortality
• respiratory distress syndrome, newborn/therapy

• Humans
• Infant, Newborn
• Randomized Controlled Trials as Topic
• Respiratory Distress Syndrome, Newborn/therapy
• Respiratory Distress Syndrome, Newborn/mortality
• Noninvasive Ventilation/methods
• High-Frequency Ventilation/methods
• Infant, Premature
• Bias
• Intubation, Intratracheal/methods
• Pulmonary Surfactants/therapeutic use

• Intensive Care Units, Neonatal
• Neonatology
• Paediatrics

• Adolescent
• Adult
• Child
• Female
• Humans
• Infant
• Infant, Newborn
• Pregnancy
• Electric Impedance
• Lung
• Prone Position/physiology
• Respiration
• Retrospective Studies
• Supine Position/physiology
• Prospective Studies

• cerebro-costo-mandibular syndrome
• costovertebral joint
• neonate respiration
• ribs

• Infant, Newborn
• Humans
• Intellectual Disability/complications
• Intellectual Disability/diagnosis
• Intellectual Disability/genetics
• Ribs/abnormalities
• Micrognathism/complications
• Micrognathism/diagnosis
• Micrognathism/genetics
• Respiratory Distress Syndrome/complications

• COVID-19, complications
• anaesthesia
• paediatrics
• perioperative care

• Intubation
• Neonate
• Safety

• Infant, Newborn
• Humans
• Intubation, Intratracheal/adverse effects
• Intubation, Intratracheal/methods
• Registries
• Prospective Studies

• K08 HS029029 AHRQ HHS
• R01 HD106996 NICHD NIH HHS

• anesthesia
• inguinal hernia
• pediatric
• perioperative
• surgery

• Humans
• Infant
• Infant, Newborn
• Hernia, Inguinal/surgery
• Infant, Premature
• Anesthesia, General
• Anesthesiology
• Laparoscopy
• Herniorrhaphy

• National Health and Medical Research Council
• Stan Perron Charitable Foundation
• National Health and Medical Research Council
• Stan Perron Charitable Foundation

• Infant
• Humans
• Pneumoperitoneum/complications
• Pulmonary Atelectasis/diagnostic imaging
• Pulmonary Atelectasis/etiology
• Pulmonary Atelectasis/prevention & control
• Lung/diagnostic imaging
• Laparoscopy/adverse effects
• Ultrasonography, Interventional

• bronchopulmonary dysplasia
• mechanical ventilation
• prematurity
• ventilation

• Infant, Newborn
• Humans
• Infant
• Child
• Female
• Male
• Laryngoscopy/adverse effects
• Laryngoscopes
• Intubation, Intratracheal/adverse effects
• Oxygen
• Critical Care

Perioperative neonatal pneumothorax (NP) is rare but very fatal. Most of the surgeries and treatments in the neonatal period are time-limited or emergent, and there are often some risk factors for pneumothorax before surgery. Physicians, surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies, patients receiving mechanical ventilation and those with underlying lung disease. The clinical presentation of NP is nonspecific, and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed. This review highlights recent progress in the identification of risk factors, clinical manifestations, diagnosis and management of NP during the perioperative period.

• Neonatal
• Perioperative
• Pneumothorax
• Risk factors
• Clinical manifestations
• Diagnosis
• Management

Many preterm infants require mechanical ventilation as life-saving therapy. However, ventilation-induced overpressure can result in lung diseases. Considering the lung as a viscoelastic material, positive pressure inside the lung results in increased hydrostatic pressure and tissue compression. To elucidate the effect of positive pressure on lung tissue mechanics and cell behavior, we mimic the effect of overpressure by employing an uniaxial load onto fetal and adult rat lungs with different deformation rates. Additionally, tissue expansion during tidal breathing due to a negative intrathoracic pressure was addressed by uniaxial tension. We found a hyperelastic deformation behavior of fetal tissues under compression and tension with a remarkable strain stiffening. In contrast, adult lungs exhibited a similar response only during compression. Young’s moduli were always larger during tension compared to compression, while only during compression a strong deformation-rate dependency was found. In fact, fetal lung tissue under compression showed clear viscoelastic features even for small strains. Thus, we propose that the fetal lung is much more vulnerable during inflation by mechanical ventilation compared to normal inspiration. Electrophysiological experiments with different hydrostatic pressure gradients acting on primary fetal distal lung epithelial cells revealed that the activity of the epithelial sodium channel (ENaC) and the sodium-potassium pump (Na,K-ATPase) dropped during pressures of 30 cmH₂O. Thus, pressures used during mechanical ventilation might impair alveolar fluid clearance important for normal lung function.

Data on safety and success rates of ultrasound‐guided caudal blockade, performed on sedated children with an uninstrumented airway, are scarce. We performed a retrospective observational study of validated data from April 2014 to December 2020 in a paediatric cohort where the initial plan for anaesthetic management was sedation and caudal epidural without general anaesthesia or airway instrumentation. We examined success rates of this approach and rates of block failure and block‐related complications. In total, 2547 patients ≤ 15 years of chronological age met inclusion criteria. Among the 2547 cases, including 453 (17.8%) former preterm patients, caudal‐plus‐sedation success rate was 95.1%. The primary anaesthesia plan was abandoned for general anaesthesia in 124 cases. Pain‐related block failure in 83 (3.2%) was the most common cause for conversion. Complications included 39 respiratory events and 9 accidental spinal anaesthetics. Higher odds of pain‐related block failure were associated with higher body weight (adjusted OR 1.063, 95%CI 1.035–1.092, p < 0.001) as well as with mid‐abdominal surgery (e.g. umbilical hernia repair) (adjusted OR 15.11, 95%CI 7.69–29.7, p < 0.001), whereas extreme (< 28 weeks) former prematurity, regardless of chronological age, was associated with higher odds (adjusted OR 3.62, 95%CI 1.38–9.5, p = 0.009) for respiratory problems. Ultrasound‐guided caudal epidural, performed under sedation with an uninstrumented airway, is an effective technique in the daily clinical routine. Higher body weight and mid‐abdominal surgical procedures are risk factors for pain‐related block failure. Patients who, regardless of chronological age, had been born as extreme preterm babies are at the highest risk for respiratory events.

• anaesthesia, caudal
• anaesthesia, epidural
• infant
• paediatrics

• anesthesia
• intraoperative care
• mechanical
• pulmonary ventilation
• ventilators

• anesthesia
• atelectasis
• lung function
• pediatric
• recruitment maneuver

• anesthetic machines
• equipment
• monitors
• respiration

• airway
• airway obstruction
• child
• compliance
• control of breathing
• growth
• physiology

The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.

• One-lung ventilation
• pediatric anesthesia
• thoracic surgery
• thoracoscopy
• thoracotomy

• automatic stepwise recruitment maneuver
• mechanical ventilation
• neonates
• recruitment maneuver
• safety

• Blood gas analysis
• exhalation
• inhalation
• pediatrics
• positive pressure breathing
• respiratory mechanics

• Blood Gas Analysis
• Child
• Humans
• Lung
• Lung Compliance
• Pulmonary Gas Exchange
• Respiration, Artificial
• Respiratory Mechanics

• infants
• kinematics
• neonatal care
• respiratory pattern
• thoracoabdominal motion
• wearable sensors

• Aerosol delivery
• Nebulizer
• Non-invasive ventilation
• Premature infants
• Pulmonary drug delivery
• Respiratory distress syndrome
• Surfactant

• Administration, Inhalation
• Aerosols
• Bronchodilator Agents/administration & dosage
• Drug Delivery Systems/instrumentation
• Drug Delivery Systems/methods
• Humans
• Infant, Newborn
• Nebulizers and Vaporizers
• Noninvasive Ventilation/instrumentation
• Noninvasive Ventilation/methods
• Premature Birth/diagnosis
• Premature Birth/drug therapy
• Premature Birth/physiopathology
• Respiratory Mechanics/drug effects
• Respiratory Mechanics/physiology

• Chiesi Farmaceutici

Bronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. For years, mild BR cases were treated with noninvasive standard oxygen therapy (SOT), i.e., with cold and poorly or totally non-humidified oxygen delivered by an ambient headbox or low-flow nasal cannula. Children with severe disease were intubated and treated with invasive mechanical ventilation (IMV). To improve SOT and overcome the disadvantages of IMV, new measures of noninvasive and more efficient oxygen administration have been studied. Bi-level positive air way pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are among them. For its simplicity, good tolerability and safety, and the good results reported in clinical studies, HFNC has become increasingly popular and is now widely used. However, consistent guidelines for initiation and discontinuation of HFNC are lacking. In this narrative review, the role of HFNC to treat infants with BR is discussed. An analysis of the literature showed that, despite its widespread use, the role of HFNC in preventing respiratory failure in children with BR is not precisely defined. It is not established whether it can offer greater benefits compared to SOT and when and in which infants it can replace CPAP or BiPAP. The analysis of the results clearly indicates the need for multicenter studies and official guidelines. In the meantime, HFNC can be considered a safe and effective method to treat children with mild to moderate BR who do not respond to SOT.

• BiPAP
• CPAP
• HFNC
• bronchiolitis
• oxygen therapy

• congenital heart disease
• congenital heart surgery
• pediatric cardiac anesthesia

• Airway management
• Anesthesia management
• Muscle relaxant
• Pediatric anesthesia
• Retinopathy

• Anesthesia, General/adverse effects
• Child, Preschool
• Humans
• Infant
• Infant, Newborn
• Infant, Premature
• Intubation, Intratracheal/adverse effects
• Laryngeal Masks
• Retinopathy of Prematurity/epidemiology
• Retinopathy of Prematurity/surgery
• Retrospective Studies

• COVID-19
• Care implications
• Neonate
• Pathophysiology
• Transmission

• children
• compliance-volume curve
• functional residual capacity
• lung compliance
• mechanical ventilation
• protective ventilation
• respiratory system mechanics

• Congenital diaphragmatic hernia
• Esophageal atresia
• Hypercapnia
• Minimally invasive surgery
• Neonatal surgery
• Thoracoscopy

Preterm infants frequently present with respiratory insufficiency requiring respiratory assistance. Invasive mechanical ventilation has been associated with several short and long term complications. Therefore, the practice of early use of non-invasive ventilation has been adopted. Nasal CPAP proved efficacy as an initial therapy for preterm infants. Non-invasive positive pressure ventilation is an alternative used to mitigate CPAP failure in infants with apnea or increased work of breathing. High flow nasal cannula gained popularity primarily due to the ease of its use, despite multiple prominent trials that demonstrated its inferiority. Bi-level positive airway pressure and neurally adjusted non-invasive ventilatory are used in infants with apnea and increased work of breathing. The effectiveness of non invasive ventilation tools can be augmented by having a proper protocol for initiation, weaning, skin care, positioning, and developmental care during their application.

• Mechanical ventilation
• Neonatal respiratory distress syndrome
• Noninvasive ventilation
• Preterm infant

• airway
• child
• device
• regional
• respiration
• technique

• paediatric anaesthesia
• patient safety
• spirometry
• ventilation

• endotracheal tube
• in vitro lung model
• pediatric
• work of breathing

• anesthesia machine
• circuit compliance
• infant
• pressure-controlled ventilation

• bronchopulmonary dysplasia
• mechanical ventilation
• neurally adjusted ventilatory assist
• tracheostomy

Cerebral oxygen saturation (rSO₂c) decrease from baseline greater than 20 % during infant cardiac surgery was associated with postoperative neurologic changes and neurodevelopmental impairment at 1 year of age. So far, there is no sufficient evidence to support the routine monitoring of rSO₂c during general surgical procedures in children. We aimed to find out the frequency of cerebral desaturation 20 % or more from baseline and to identify possible predictors of change in cerebral oxygen saturation during neonatal and infant general surgery.

Forty-four infants up to 3 months of age were recruited. Before induction of anesthesia, two pediatric cerebral sensors were placed bilaterally to the forehead region and monitoring of regional cerebral saturation of oxygen was started and continued throughout the surgery. Simultaneously, mean arterial blood pressure (MAP), pulse oximetry (SpO₂), heart rate (HR), endtidal CO₂, expired fraction of sevoflurane and rectal temperature were recorded. The main outcome measure was rSO₂c value drop-off ≥20 % from baseline. Mann-Whitney U-test, chi-squared test, simple and multiple linear regression models were used for statistical analysis.

Forty-three infants were analyzed. Drop-off ≥20 % in rSO₂c from baseline occurred in 8 (18.6 %) patients. There were no differences in basal rSO₂c, SpO₂, HR, endtidal CO₂, expired fraction of sevoflurane and rectal temperature between patients with and without desaturation 20 % or more from baseline. But the two groups differed with regard to gestation, preoperative mechanical ventilation and the use of vasoactive medications and red blood cell transfusions during surgery. Simple linear regression model showed, that gestation, age, preoperative mechanical ventilation and mean arterial pressure corresponding to minimal rSO₂c value during anesthesia (MAP_minrSO2c) were associated with a change in rSO₂c values. Multiple regression model including all above mentioned variables, revealed that only MAP_minrSO2c was predictive for a change in rSO₂c values (β (95 % confidence interval) -0.28 (−0.52–(−0.04)) p = 0.02).

Cerebral oxygen desaturation ≥20 % from baseline occurred in almost one fifth of patients. Although different perioperative factors can predispose to cerebral oxygenation changes, arterial blood pressure seems to be the most important. Gestation as another possible risk factor needs further investigation.

The international registration number NCT02423369. Retrospectively registered on April 2015.

The online version of this article (doi:10.1186/s12871-016-0274-2) contains supplementary material, which is available to authorized users.

• Anesthesia
• Cerebral oxygenation
• Near-infrared spectroscopy
• Neonates

• Children
• Compliance–volume curve
• Functional residual capacity
• Lung compliance
• Mechanical ventilation
• Protective ventilation
• Respiratory system mechanics