{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:01:15Z","timestamp":1791489675525,"version":"4.3.4"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T00:00:00Z","timestamp":1639699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Background and aim:<\/jats:bold> Neonatal brain monitoring is increasingly used due to reports of brain injury perioperatively. Little is known about the effect of sedatives (midazolam) and anesthetics (sevoflurane) on cerebral oxygenation (rScO<jats:sub>2<\/jats:sub>) and cerebral activity. This study aims to determine these effects in the perioperative period.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This is an observational, prospective study in two tertiary pediatric surgical centers. All neonates with a congenital diaphragmatic hernia received perioperative cerebral oxygenation and activity measurements. Patients were stratified based on intraoperatively administrated medication: the sevoflurane group (continuous sevoflurane, bolus fentanyl, bolus rocuronium) and the midazolam group (continuous midazolam, continuous fentanyl, and continuous vecuronium).<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Intraoperatively, rScO<jats:sub>2<\/jats:sub> was higher in the sevoflurane compared to the midazolam group (84%, IQR 77\u201395 vs. 65%, IQR 59\u201376, <jats:italic>p<\/jats:italic> = &amp;lt; 0.001), fractional tissue oxygen extraction was lower (14%, IQR 5\u201321 vs. 31%, IQR 29\u201340, <jats:italic>p<\/jats:italic> = &amp;lt; 0.001), the duration of hypoxia was shorter (2%, IQR 0.4\u20139.6 vs. 38.6%, IQR 4.9\u201370, <jats:italic>p<\/jats:italic> = 0.023), and cerebral activity decreased more: slow delta: 2.16 vs. 4.35 \u03bc<jats:italic>V<\/jats:italic><jats:sup>2<\/jats:sup> (<jats:italic>p<\/jats:italic> = 0.0049), fast delta: 0.73 vs. 1.37 \u03bc<jats:italic>V<\/jats:italic><jats:sup>2<\/jats:sup> (<jats:italic>p<\/jats:italic> = &amp;lt; 0.001). In the first 30 min of the surgical procedure, a 3-fold increase in fast delta (10.48\u201331.22 \u03bc<jats:italic>V<\/jats:italic><jats:sup>2<\/jats:sup>) and a 5-fold increase in gamma (1.42\u20137.58 \u03bc<jats:italic>V<\/jats:italic><jats:sup>2<\/jats:sup>) were observed in the midazolam group.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Sevoflurane-based anesthesia resulted in increased cerebral oxygenation and decreased cerebral activity, suggesting adequate anesthesia. Midazolam-based anesthesia in neonates with a more severe CDH led to alarmingly low rScO<jats:sub>2<\/jats:sub> values, below hypoxia threshold, and increased values of EEG power during the first 30 min of surgery. This might indicate conscious experience of pain. Integrating population-pharmacokinetic models and multimodal neuromonitoring are needed for personalized pharmacotherapy in these vulnerable patients.<\/jats:p><jats:p><jats:bold>Trial Registration:<\/jats:bold><jats:ext-link>https:\/\/www.trialregister.nl\/trial\/6972<\/jats:ext-link>, identifier: NL6972.<\/jats:p>","DOI":"10.3389\/fped.2021.798952","type":"journal-article","created":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T08:01:37Z","timestamp":1639728097000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Cerebral Oxygenation and Activity During Surgical Repair of Neonates With Congenital Diaphragmatic Hernia: A Center Comparison Analysis"],"prefix":"10.3389","volume":"9","author":[{"given":"Sophie 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