Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 06 16 1534 1534 Sonal Khatavkar Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Amruta Chaudhari Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2025 12 21 2026 01 06 Meningomyelocele (MMC) is a neural tube defect associated with significant perioperative challenges, particularly when complicated by rupture and sepsis. Anesthetic management in such neonates is demanding due to physiological immaturity, hemodynamic instability, and risks of hypothermia and metabolic derangements. We report the perioperative anesthetic management of a 16‑day‑old preterm neonate weighing 1.72 kg with a ruptured lumbosacral meningomyelocele and clinical sepsis who underwent emergency surgical repair. The neonate presented with fever, tachycardia, poor feeding, metabolic acidosis, hypoglycemia, and purulent discharge from the lesion. After preoperative stabilization, anesthesia was induced in the lateral position using fentanyl and propofol, followed by tracheal intubation and prone positioning. Intraoperative management focused on temperature regulation, hemodynamic stability, and glucose control. Postoperatively, the neonate was monitored in the neonatal intensive care unit with a favorable outcome. Anesthetic management of ruptured meningomyelocele in a septic neonate requires meticulous planning, careful positioning, strict asepsis, and vigilant perioperative monitoring. Early stabilization and multidisciplinary coordination are essential for successful outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1534