As each year passes, there are advances in the perioperative management of critically ill newborns who require surgery. Developments in surgical techniques and equipment available have facilitated challenging surgical repairs in smaller infants. 1 , 2 This has been coupled with new anesthesia modalities, in particular with regard to regional anesthesia, and rapidly metabolized medications such as desflurane and remifentanil. 3 5 Increased operative intervention in preterm and low-birth-weight infants has increased the demand for postoperative high-dependency and intensive care.6 Alternative respiratory and cardiovascular support in the form of extracorporeal life support, inhaled nitric oxide (NO), and high-frequency oscillation have expanded the potential to support these severely compromised infants.