Effects of Low-Pressure CO2 Insufflation on Cerebral and Splanchnic Oxygenation in Neonates Undergoing Laparoscopic Pyloromyotomy.

Pathophysiological effects of abdominal CO2 insufflation on cerebral and splanchnic oxygenation in neonates and infants undergoing laparoscopy remain poorly investigated. We investigated laparoscopic pyloromyotomy as a paradigm to determine such changes in this specific population.Single-center, prospective cohort of 28 infants undergoing laparoscopic pyloromyotomy at the mean age of 30.9 ± 10.6 days. The pneumoperitoneum was set at 6 to 8 mmHg. Regional cerebral oxygen saturation (cSO2) and splanchnic oxygen saturation (sSO2) were measured by near-infrared spectroscopy. End-tidal carbon dioxide (EtCO2) levels, heart rate, body temperature, systemic blood pressure, and urine output were also recorded. Data (mean ± SD) were collected intraoperatively at 0, 15, and 30 minutes and compared to baseline values for each patient using the t-test.A significant decrease in cSO2 was recorded only at the beginning of surgery, while sSO2 significantly decreased from 15 intraoperative minutes (-7.1% ± 7.2; p = 0.0009) until the end of insufflation, followed by an increasing trend, although still below the baseline values (-6.5% ± 11.2; p = 0.01). EtCO2 increased significantly from the initial 15 intraoperative minutes, reaching a maximum of 42.6 ± 8.9 mmHg at 30-minute intervals. Urine output significantly decreased within the first 4 postoperative hours.Laparoscopic pyloromyotomy using low-pressure CO2 insufflation (6-8 mmHg) maintains stable cerebral oxygenation in neonates and infants, while splanchnic oxygenation and urine output experience temporary, reversible reductions. These findings suggest that low-pressure pneumoperitoneum is a safe and effective approach in neonatal laparoscopy, with minimal oxygenation and metabolic risks.