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CC BY-NC-ND 4.0 · AJP Rep 2018; 08(03): e192-e194
DOI: 10.1055/s-0038-1668565
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Monitoring of Blood Pressure is not Enough to Avoid Neonatal Postoperative Encephalopathy

Simón Pedro Lubián López
1   Neonatology Department, “Puerta del Mar” University Hospital, Cadiz, Spain. Fundación Nene (Neonatal Neurology Research Group
,
Amaya Zuazo Ojeda
2   Radiology Department, “Puerta del Mar” University Hospital, Cadiz, Spain
,
Gema Jimenez Gómez
3   Research Unit, “Puerta del Mar” University Hospital, Cadiz, Spain
,
Isabel Benavente Fernández
1   Neonatology Department, “Puerta del Mar” University Hospital, Cadiz, Spain. Fundación Nene (Neonatal Neurology Research Group
› Author Affiliations
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Publication History

22 January 2017

15 February 2017

Publication Date:
20 September 2018 (online)

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Abstract

Background Neonatal encephalopathy with seizures after general anesthesia not occurring in infants undergoing cardiac or major neurosurgery is very uncommon. An ischemic origin due to cerebral hypoperfusion from perioperative hypotension has been suggested, but there is a lack of a consensus definition for intraoperatory hypotension in neonates.

Case Report We report the first case of neonatal encephalopathy with seizures in a neonate with anorectal malformation. He underwent a colostomy with caudal anesthesia combined with light general anesthesia. Intraoperative systolic blood pressure and mean blood pressure values were considered normal. Thirty-two hours after the intervention, the patient presented electroclinical seizures. Diffusion-weighted imaging showed bilateral involvement with reduced diffusivity in the watershed areas of the middle cerebral artery and posterior cerebral artery.

Conclusion Perioperative monitoring of blood pressure is not enough in neonatal surgery. Cerebral magnetic resonance imaging should be considered in infants with noncardiac congenital anomalies after neonatal surgery and long-term follow-up is required.

Keywords

encephalopathy - postoperative - hypotension - caudal anesthesia - diffusion-weighted imaging - neonate
 

  • References

  • 1 McCann ME, Schouten AN, Dobija N. , et al. Infantile postoperative encephalopathy: perioperative factors as a cause for concern. Pediatrics 2014; 133 (03) e751-e757
    CrossrefPubMedGoogle Scholar
  • 2 Stolwijk LJ, Keunen K, de Vries LS. , et al. Neonatal surgery for noncardiac congenital anomalies: neonates at risk of brain injury. J Pediatr 2017; 182: 335-341.e1
    CrossrefPubMedGoogle Scholar
  • 3 de Vries LS, Groenendaal F. Patterns of neonatal hypoxic-ischaemic brain injury. Neuroradiology 2010; 52 (06) 555-566
    CrossrefPubMedGoogle Scholar
  • 4 de Graaff JC, Pasma W, van Buuren S. , et al. Reference values for noninvasive blood pressure in children during anesthesia: a multicentered retrospective observational cohort study. Anesthesiology 2016; 125 (05) 904-913
    CrossrefPubMedGoogle Scholar
  • 5 Harteman JC, Groenendaal F, Toet MC. , et al. Diffusion-weighted imaging changes in cerebral watershed distribution following neonatal encephalopathy are not invariably associated with an adverse outcome. Dev Med Child Neurol 2013; 55 (07) 642-653
    CrossrefPubMedGoogle Scholar