Extremely low birth weight (ELBW) neonates for emergency surgery- A challenge for the Anesthesiologist: A case series





Neonate, Preterm, Extremely low birth weight, Anesthesia, Emergency surgery, Unique


Background: Extremely Low Birth Weight (ELBW) newborns, defined as those with a birth weight of 1000 grams or less, present challenging anesthetic scenarios. Emergency surgeries in these infants elevate their vulnerability to various complications.

Case Presentation: We present a case series involving 5 ELBW neonates who underwent emergency surgery. Three of them were at a post-conceptual age (PCA) of ≥ 33 weeks and underwent procedures for congenital birth defects, including esophageal atresia, ileal atresia, and gastroschisis. The remaining two neonates, with a PCA of 29-30 weeks, underwent surgery for necrotizing enterocolitis (NEC).

Conclusion: The compromised physiology resulting from distinct disease processes and the underdeveloped systems of ELBW preterm neonates necessitate focused care and strategic anesthesia. This approach is crucial to mitigate morbidity and mortality risks in such vulnerable patients.


Download data is not yet available.


Metrics Loading ...

Author Biographies

Preeti Goyal Varshney, Lady Hardinge Medical College, New delhi

Associate Professor, Department of Anaesthesia

Madhurima Sinharay, Lady Hardinge Medical College

Ex-Senior Resident, Department of Anaesthesia

Anshu Gupta, Lady Hardinge Medical College

Director Professor, Department of Anaesthesia

Maitree Pandey, Lady Hardinge Medical College

Director Professor and Head of Department, 

Department of Anaesthesia


Subramaniam R. Anaesthetic concerns in preterm & term neonates. Indian J Anaesth. 2019;63:771-9.

Ohuma E, Moller A-B, Bradley E, et al. National, regional, and worldwide estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023;402:1261-71. doi:10.1016/S0140-6736(23)00878-4.

Ogawa M, Matsuda Y, Kanda E, Konno J, Mitani M, Makino Y, et al. Survival rate of extremely low birth weight infants and its risk factors: Case control study in Japan. ISRN Obstet Gynecol. 2013;25:873563. doi: 10.1155/2013/873563.

Feng, X, Thomé U, Stepan H, Lacher M, Wagner R. Surgical treatment of oesophageal atresia with lower tracheoesophageal fistula in an extremely preterm infant (510 g, 25 + 5 weeks): a case report. J Med Case Rep. 2021;15:361. doi: 10.1186/s13256-021-02951-x.

Wei Y, Zhu Y, Luo X, Chen L, & Hu X. Case Report: Is Pneumoperitoneum the Only Indication for Surgery in Necrotizing Enterocolitis? Front Pediatr. 2021;9:714540. doi: 10.3389/fped.2021.714540.

Joshi S, Dwivedi D, Kaur R, Bala I. Anaesthetic management of an Extremely Low Birth Weight (ELBW) neonate with multiple co-morbidities. Indian J Clin Anaesth. 2018;5:162-4. doi: 10.18231/2394-4994.2018.0029.

Williams A, George PE, Dua V. Anesthetic considerations in a preterm: Extremely low birth weight neonate posted for exploratory laparotomy. Anesth Essays Res. 2012;6:81-3. doi: 10.4103/0259-1162.103382.

Adams SD, Stanton MP. Malrotation and intestinal atresias. Early Hum Dev. 2014;90:921-5.

Lund C, Nonato L, Kuller J, et al. Disruption of barrier function in neonatal skin associated with adhesive removal. J Pediatr. 1997;131:367-72.

Eichenwald EC, Stark AR. Management and outcomes of very low birth weight baby. N Engl J Med. 2008;358:1700-11.

Visram AR. Intraoperative fluid therapy in neonates. S Afr J Anaesth Analg. 2016;22:46-51.

Welbborn LG, de Soto H, Hannallah RS, Fink R, Ruttimann UE, Boeckx R. The use of caffeine in the control of post anesthetic apnea in former premature infants. Anesthesiol. 1988;68:796-8.




How to Cite

Varshney PG, Sinharay M, Gupta A, Pandey M. Extremely low birth weight (ELBW) neonates for emergency surgery- A challenge for the Anesthesiologist: A case series. J Neonatal Surg [Internet]. 2024Mar.14 [cited 2024Jul.21];13:14. Available from: https://jneonatalsurg.com/ojs/index.php/jns/article/view/1294