Can a Neonate Shiver ? — A perioperative Diagnostic Dilemma and a Short Literature Review

Background: Neonates often show involuntary movements peri-operatively which are difficult to diagnose. Neonatal Shivering albeit very rare, may confuse the anaesthesiologist by presenting as Seizures. Case : A Neonate was scheduled for the repair of Lumbar Meningomyelocele in our Operating Room. At the end of an uneventful Surgery, we noticed jittery movements during recovery from Anaesthesia. Differentiating these movements from Neonatal Shivering, Motor Automatisms and Physiological New-born Behaviour was a challenge. The immediate venous blood gas analysis was within normal limits and no apparent cause could be found. Suspecting accidental Hypothermia, Immediate rewarming was initiated and after Consulting Paediatric Neurology intravenous Levetiracetam was given. There were no further similar episodes. Conclusion : Shivering-like episodes in Neonates during the peri-operative period need to be carefully evaluated to allay parental anxiety, avoid inappropriate treatment and prevent any further complications

Anesthetic dilemma in planning bilateral cataract surgery for an infant associated with congenital cardiac anomaly.

In a patient with tetralogy of Fallot (TOF) and pulmonary atresia, treating the cardiac problem or the associated congenital illness is always a challenge. We describe the challenges and successful initial management of bilateral cataract to prevent visual loss in an infant with TOF with pulmonary atresia.