Predictors, Management and Outcomes of Perioperative Hypotension in Infants and Young Children: A Scoping Review

Perioperative hypotension is common during pediatric anesthesia yet lacks a universally accepted definition, particularly in infants and young children who undergo rapid changes in physiology. Thresholds for intervention vary widely between age groups and centers and are largely based on expert opinion and local practice rather than outcome‑validated cut‑offs. Large pediatric cohorts show that intervention thresholds (e.g., age‑specific MAP values) are substantially lower in younger children, with fluids and vasopressors used heterogeneously to treat hypotension. In neonates and infants, hypotension is associated with increased morbidity and mortality. Adult and mixed‑age reviews showed an association between intraoperative hypotension and renal injury, myocardial injury, delirium, and mortality, but pediatric data is limited. In particular, the literature on newborn and preterm infants has shown significant variability in both treatment thresholds and the choice of therapy for hypotension, with a lack of standardized evidence to guide practice. A focused synthesis of predictors and management strategies for perioperative hypotension in infants and young children is currently lacking. As such, our objective is to identify, summarize, and analyze predictors, definitions/thresholds, and management strategies for perioperative hypotension in infants and young children undergoing anesthesia, and to describe any reported associations with short‑ and long‑term clinical outcomes.