新生儿非心脏手术后转入新生儿重症监护病房的围手术期相关因素

doi:10.20274/j.cnki.issn.1674-3865.2026.05.007

Abstract

Abstract:

Objective To identify factors associated with postoperative neonatal intensive care unit(NICU) admission in neonates without preoperative advanced life support. Methods We retrospectively included 450 neonates who underwent noncardiac surgery under general anesthesia with tracheal intubation at Hunan Children's Hospital from April 2024 to March 2026 and divided them into two groups based on where they were sent after surgery. Perioperative data were compared between the NICU group(n=41) and the non-NICU group (n=409). Multivariable binary Logistic regression analysis was performed. Results NICU admission occurred in 9.1%(41/450). Multivariable binary Logistic regression analysis showed that adjusted gestational age at surgery was negatively associated with NICU admission(OR=0.697 per week increased),whereas American Society of Anesthesiologists(ASA) physical status, intraoperative hypoxemia, and anesthesia duration were positively associated with NICU admission(OR=3.700 per grade increased for ASA grading, OR=2.946 per 10 min increased in intraoperative hypoxemia, and OR=1.164 per 10 min increased in anesthesia duration, respectively; all P<0.05). Conclusion Postoperative NICU admission is associated with preoperative maturity, overall disease condition, intraoperative oxygenation, and anesthesia duration. After surgery, the monitoring grade and transfer pathway may be reassessed based on the data before and during surgery.

Key words: Neonate, Neonatal intensive care unit, Noncardiac surgery, Adjusted gestational age at surgery, Hypoxemia

CLC Number:

R722.1

Xiaoxiao YANG, Siwei WEI, Lei WU, Zhen DU. Perioperative factors associated with NICU admission after noncardiac surgery in neonates[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2026, 18(5): 408-412.

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References 30

[1]	Bertolizio G, Disma N, Engelhardt T. After nectarine: how should we provide anesthesia for neonates?[J]. Curr Opin Anaesthesiol, 2022,35(3):337-342.
[2]	Disma N, Veyckemans F, Virag K, et al. 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)[J]. Br J Anaesth, 2021,126(6):1157-1172.
[3]	Fuchs A, Disma N, Engelhardt T,et al. Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants: a secondary analysis of the NECTARINE cohort[J]. Br J Anaesth, 2025,135(5):1528-1536.
[4]	Michelet D, Brasher C, Kaddour HB, et al. Postoperative complications following neonatal and infant surgery: Common events and predictive factors[J]. Anaesth Crit Care Pain Med, 2017,36(3):163-169.
[5]	Essa S, Mogane P, Moodley Y, et al. Risk factors associated with unplanned ICU admissions following paediatric surgery: A systematic review[J]. South Afr J Crit Care, 2022,38(2):53-59.
[6]	Tsuboi K, Ninagawa J, Tsuboi N, et al. Unplanned admission to pediatric intensive care after general anesthesia: A seven-year retrospective cohort study in a tertiary children's hospital[J]. Paediatr Anaesth, 2022,32(1):56-61.
[7]	Lian C, Xie Z, Wang Z, et al. Pediatric preoperative risk factors to predict postoperative ICU admission and death from a multicenter retrospective study[J]. Paediatr Anaesth, 2016,26(6):637-643.
[8]	Taylor KL, Frndova H, Szadkowski L, et al. Risk factors for unplanned paediatric intensive care unit admission after anaesthesia-an international multicentre study[J]. Paediatr Child Health, 2022,27(6):333-339.
[9]	Nelson O, Rintoul NE, Tan JM, et al. Surgical neonates: A retrospective review of procedures and postoperative outcomes at a quaternary children's hospital[J]. Paediatr Anaesth, 2024,34(4):354-365.
[10]	Bucher BT, Duggan EM, Grubb PH, et al. Does the American College of Surgeons National Surgical Quality Improvement Program pediatric provide actionable quality improvement data for surgical neonates?[J]. J Pediatr Surg， 2016，51(9):1440-1444.
[11]	Habre W, Disma N, Virag K, et al. Incidence of severe critical events in paediatric anaesthesia(APRICOT): a prospective multicentre observational study in 261 hospitals in Europe[J]. Lancet Respir Med， 2017，5(5):412-425.
[12]	Long JB, Fiedorek MC, Oraedu O, et al. Neonatal intensive care unit patients recovering in the post anesthesia care unit: An observational analysis of postextubation complications[J]. Paediatr Anaesth， 2019，29(12):1186-1193.
[13]	Engle WA,American Academy of Pediatrics Committee on Fetus and Newborn. Age terminology during the perinatal period[J]. Pediatrics, 2004,114(5):1362-1364.
[14]	Dalal PG, Malviya S, Coté CJ, et al. Postanesthesia Apnea in Former Preterm and Term Infants: A Qualitative Systematic Review and Meta-analysis[J]. Anesthesiology, 2026,144(6):1454-1469.
[15]	Coté CJ, Zaslavsky A, Downes JJ, et al. Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis[J]. Anesthesiology， 1995，82(4):809-822.
[16]	Davidson AJ, Morton NS, Arnup SJ, et al. Apnea after awake regional and general anesthesia in infants: the general anesthesia compared to spinal anesthesia study--comparing apnea and neurodevelopmental outcomes, a randomized controlled trial[J]. Anesthesiology， 2015，123(1):38-54.
[17]	Catre D, Lopes MF, Madrigal A,et al. Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn[J]. Rev Bras Epidemiol， 2013，16(4):943-952.
[18]	Jin C, Zhao J, Cai BB, et al. Risk factors for and outcomes of intraoperative desaturation in neonates undergoing non-cardiac surgery: a retrospective study[J]. World J Pediatr Surg， 2025，8(5):e001036.
[19]	Udupa AN, Ravindra MN, Chandrika YR, et al. Comparison of pediatric perioperative risk assessment by ASA physical status and by NARCO-SS(neurological, airway, respiratory, cardiovas⁃cular, other-surgical severity) scores[J]. Paediatr Anaesth， 2015，25(3):309-316.
[20]	von Ungern-Sternberg BS, Boda K, Chambers NA, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study[J]. Lancet， 2010，376(9743):773-783.
[21]	Tait AR, Malviya S, Voepel-Lewis T, et al. Risk factors for perio⁃perative adverse respiratory events in children with upper respira⁃tory tract infections[J]. Anesthesiology， 2001，95(2):299-306.
[22]	Cai BB, Wang DP. Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study[J]. World J Pediatr Surg， 2023，6(4):e000657.
[23]	da Silva PS, de Aguiar VE, Fonseca MC. Risk factors and outcomes of unplanned PICU postoperative admissions: a nested case-control study[J]. Pediatr Crit Care Med， 2013，14(4):420-428.
[24]	Hansen TG, Vieri J, Børke WB, et al. Outcome following anaesthesia in infancy in the Nordic countries: Subgroup analysis of the NECTARINE study[J]. Acta Anaesthesiol Scand， 2023，67(6):714-723.
[25]	Berens RJ, Greene CC, Frahm CE, et al. Does anesthesia duration or number of cases per patient predict safety events?[J]. Paediatr Anaesth， 2024，34(6):568-574.
[26]	Partain KN, Mpody C, Rodgers B, et al. Prolonged Postoperative Mechanical Ventilation (PPMV) in children undergoing abdominal operations: An analysis of the American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database[J]. J Pediatr Surg， 2021，56(6):1114-1119.
[27]	Qian M, Zhao J, Zhang K, et al. High intraoperative fluid load associated with prolonged length of hospital stay and complications after non-cardiac surgery in neonates[J]. Eur J Pediatr， 2024，183(9):3739-3748.
[28]	Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis[J]. J Clin Epidemiol， 1996，49(12):1373-1379.
[29]	Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression[J]. Am J Epidemiol， 2007，165(6):710-718.
[30]	Fewell Z, Davey Smith G, Sterne JA. The impact of residual and unmeasured confounding in epidemiologic studies: a simulation study[J]. Am J Epidemiol， 2007，166(6):646-655.

变量	总体（n=450）	非NICU组（n=409）	NICU组（n=41）	U/χ²/t值	P值
术时日龄[M（P₂₅,P₇₅）,d]	5（2，12）	5（2，13）	3（2，7）	6 160.000	0.005
出生胎龄[M（P₂₅,P₇₅），周]	38.43（37.14，39.43）	38.43（37.29，39.43）	37.14（33.86，38.14）	5 111.000	<0.001
术时矫正胎龄[M（P₂₅,P₇₅），周]	39.29（38.00，40.71）	39.43（38.14，40.86）	37.43（34.14，38.57）	4 230.500	<0.001
早产儿[n（%）]	93（20.7）	74（18.1）	19（46.3）	18.137	<0.001
出生体质量[M（P₂₅,P₇₅）,kg]	3.10（2.70，3.40）	3.10（2.75，3.42）	2.60（1.89，3.05）	4 255.000	<0.001
术前体质量（x±s，kg）	3.04±0.64	3.10±0.60	2.42±0.71	5.839	<0.001
术前体质量<2.5 kg[n（%）]	75（16.7）	55（13.4）	20（48.8）	33.496	<0.001
男性[n（%）]	306（68.0）	282（68.9）	24（58.5）	1.857	0.173
ASA分级[n（%）]				28.464	<0.001
Ⅰ级	0（0.0）	0（0.0）	0（0.0）
Ⅱ级	72（16.0）	70（17.1）	2（4.9）
Ⅲ级	355（78.9）	327（80.0）	28（68.3）
Ⅳ级	23（5.1）	12（2.9）	11（26.8）
术前呼吸系统异常[n（%）]	91（20.2）	67（16.4）	24（58.5）	41.047	<0.001
术前心脏畸形[n（%）]	224（49.8）	200（48.9）	24（58.5）	1.350	0.245
术前CRP升高[n（%）]	70（23.9）	58（22.4）	12（35.3）	2.751	0.097
术前血红蛋白[M（P₂₅,P₇₅）,g/L]	156（134，172）	156（134，172）	157（143，171）	8 218.000	0.834
白蛋白[M（P₂₅,P₇₅）,g/L]	36.00（33.60，37.90）	36.15（33.90，37.90）	33.40（30.40，34.60）	4 772.000	<0.001

变量	总体（n=450）	非NICU组（n=409）	NICU组（n=41）	U/χ² 值	P值
急诊手术[n（%）]	268（59.6）	233（57.0）	35（85.4）	12.476	<0.001
手术类型[n（%）]				-	<0.001
腹腔镜	131（29.1）	128（31.3）	3（7.3）
胸腔镜	32（7.1）	21（5.1）	11（26.8）
开放/其他	287（63.8）	260（63.6）	27（65.9）
手术分级[n（%）]				11.764	0.003
Ⅰ级	0（0.0）	0（0.0）	0（0.0）
Ⅱ级	3（0.7）	3（0.7）	0（0.0）
Ⅲ级	324（72.0）	304（74.3）	20（48.8）
Ⅳ级	123（27.3）	102（24.9）	21（51.2）
麻醉时间[M（P₂₅,P₇₅）,min]	121（72.75，155）	115（66，152）	163（130，210）	3 923.500	<0.001
术中最高气道压[M（P₂₅,P₇₅）,cmH?O]	18（16，21）	18（16，20）	21（18，25）	5 672.500	0.001
呼气末二氧化碳分压[M（P₂₅,P₇₅）,mmHg]	42（37，47）	42（37，47）	42（35，49）	8 232.000	0.888
术中低体温[n（%）]	249（55.3）	222（54.3）	27（65.9）	2.020	0.155
术中低血压[n（%）]	204（45.3）	183（44.7）	21（51.2）	0.631	0.427
术中低氧血症[n（%）]	56（12.4）	41（10.0）	15（36.6）	24.128	<0.001
术中输血[n（%）]	24（5.3）	18（4.4）	6（14.6）	-	0.015
术中血管活性药物使用[n（%）]	39（8.7）	26（6.4）	13（31.7）	-	<0.001

因素	B	SE	Wald χ2值	校正OR（95%CI）	P值
术时矫正胎龄（每增加1周）	-0.360	0.084	18.480	0.697（0.592～0.822）	<0.001
ASA分级（每升高1级）	1.308	0.506	6.686	3.700（1.373～9.976）	0.010
术前呼吸系统异常（是与否）	0.717	0.416	2.970	2.048（0.906～4.628）	0.085
术中低氧血症（是与否）	1.080	0.472	5.249	2.946（1.169～7.423）	0.022
麻醉时间（每增加10 min）	0.152	0.037	16.989	1.164（1.083～1.251）	<0.001

Perioperative factors associated with NICU admission after noncardiac surgery in neonates

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