Ex-Premature Infant Postoperative Monitoring — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePaediatric AnaesthesiaEx-Premature Infant Postoperative MonitoringFRCA Final

An otherwise well 6-week-old infant, born at 32 weeks’ gestation and now 38 weeks’ postmenstrual age, undergoes inguinal hernia repair under general anaesthesia. Which postoperative disposition is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Overnight inpatient cardiorespiratory monitoring

The infant’s postmenstrual age is 32 weeks at birth plus 6 postnatal weeks, giving 38 weeks. Ex-premature infants at this age have immature ventilatory control and a substantial risk of postoperative apnoea, bradycardia and desaturation, particularly after general anaesthesia. Current RCoA guidance states that significantly ex-preterm infants should generally not be managed as day cases until approximately 60 weeks corrected age. This infant therefore requires overnight admission with cardiorespiratory monitoring. Four- or six-hour observation is inadequate. Although first events in published studies generally occurred within 12 hours, a fixed 12-hour pathway permitting same-day discharge does not meet the usual UK disposition for such a markedly immature ex-preterm infant. Routine 48-hour critical care admission is unnecessary if the infant remains stable and has no additional risk factors.

Reference: Royal College of Anaesthetists. Guidelines for the Provision of Paediatric Anaesthesia Services 2025, section 3.37: Day care procedures and anaesthesia. https://www.rcoa.ac.uk/gpas/chapter-10