The 25-year incidence and progression of hearing loss in the Framingham offspring study
JAMA Network Open
About The Study: The findings of this study suggest that hearing loss is a common public health concern that may be at least partially preventable.
Corresponding Author: To contact the corresponding author, Lauren K. Dillard, PhD, email dillalau@musc.edu.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2025.39371)
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JAMA Network Open
Gentle anesthesia, stronger outcomes: Safer surgeries for fragile newborns
image:
Flow chart of the study. GA, general anesthesia; NICU, neonatal intensive care unit; PMA, postmenstrual age.
view moreCredit: Pediatric Discovery
For premature infants, surgery often poses a life-threatening challenge due to their fragile cardiopulmonary systems. General anesthesia, while widely used, carries high risks of apnea and prolonged intensive care. Now, new evidence from India points to a gentler and safer approach. A six-year analysis of neonatal inguinal hernia surgeries found that spinal anesthesia can be performed safely even in the tiniest preterm babies. None of the infants experienced respiratory distress, apnea, or hemodynamic instability, and all recovered quickly. The findings highlight spinal anesthesia as a practical, low-risk alternative that could redefine surgical care for vulnerable newborns.
Every year, more than 13 million babies are born prematurely worldwide, and up to one-third of them require surgical repair of inguinal hernias—a procedure that, under general anesthesia, carries significant postoperative risks such as apnea, bradycardia, and desaturation. These complications often extend hospital stays and increase healthcare costs. The vulnerability of preterm infants has prompted clinicians to search for anesthesia methods that minimize these dangers without compromising surgical safety. Because of these challenges, researchers have sought to systematically evaluate spinal anesthesia as a potentially safer alternative for inguinal hernia repair in this high-risk population.
A team from Manipal Hospital in Bangalore, India, has published (DOI: 10.1002/pdi3.70015) new findings in Pediatric Discovery (July 24, 2025) revealing the success of spinal anesthesia for preterm infants undergoing inguinal hernia surgery. Reviewing six years of clinical experience, the researchers analyzed 19 neonatal cases—some as early as 27 weeks’ gestation—and found no incidents of apnea, cardiovascular instability, or postoperative complications. The results underscore how a well-refined spinal anesthesia protocol can safeguard even the most delicate patients, offering a transformative alternative to general anesthesia in neonatal surgery.
Between 2017 and 2023, the Manipal team treated 19 preterm infants—each under 50 weeks of postmenstrual age—using spinal anesthesia for inguinal hernia repair. The technique involved administering 0.5% heavy bupivacaine through a fine 26-gauge needle, ensuring precise dosing and stable anesthesia. The infants' birth weights ranged from 740 to 3300 grams, and none required conversion to general anesthesia or postoperative respiratory support. Even among four infants with bronchopulmonary dysplasia—a condition that greatly increases anesthesia risk—no cases of apnea or hemodynamic instability were observed.
All surgeries were completed within an hour, and most babies were discharged within four hours after short observation. Compared with international reports, these infants were younger and smaller yet experienced equally safe outcomes, demonstrating the robustness of the hospital’s neonatal anesthesia protocol. The findings strengthen growing global evidence that spinal anesthesia can minimize perioperative risks, shorten hospital stays, and improve recovery for high-risk newborns.
“Performing surgery on premature infants has always been one of the greatest challenges in medicine,” said senior neonatologist Dr. Karthik Nagesh, who led the study. “Our experience shows that spinal anesthesia can make these procedures far safer. It prevents the apnea and cardiorespiratory complications we often fear after general anesthesia, even in infants with lung disease. This technique not only protects the most fragile babies but also allows them to recover quickly and return home the same day—a remarkable shift in neonatal surgical care.”
The study offers compelling real-world evidence that spinal anesthesia can safely replace general anesthesia for inguinal hernia repair in premature infants. Its success in an Indian tertiary hospital highlights its potential to improve surgical safety in resource-limited settings, where neonatal intensive care units are often overstretched. By reducing the need for postoperative ventilation and monitoring, spinal anesthesia could significantly cut healthcare costs and ease the burden on families. Broader adoption, supported by multicenter clinical validation and specialized training for anesthesiologists, could make this gentle yet effective technique the new standard for neonatal surgeries worldwide.
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References
DOI
Original Source URL
https://doi.org/10.1002/pdi3.70015
About Pediatric Discovery
Pediatric Discovery is a Gold Open Access publication and peer-reviewed international journal. The journal aims to advance the health and well-being of infants, children, and adolescents by disseminating cutting-edge discovery and knowledge in the field. It provides a platform for publishing and discussing the most important and state-of-the-art basic, translational and clinical discoveries affecting child and adolescent health and disorders in all aspects of pediatric medicine. The journal has been indexed by DOAJ and PMC. Currently, it does not charge any submission fees. The Article Publication Charge (APC) is currently waived for accepted manuscripts.
Journal
Pediatric Discovery
Subject of Research
Not applicable
Article Title
Early Forays Into Using Spinal Anesthesia for Inguinal Hernia Surgery in Preterm Infants: A Retrospective Analysis From a Single Center in Karnataka
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