This letter is intended to present an innovative approach to regional anesthesia (RA) in small ex-premature babies.Preterm infants often have a history of apnea of prematurity, bronchopulmonary dysplasia and chronic lung disease. Spinal anesthesia is a well-accepted anesthetic technique for ex-premature infants undergoing lower abdominal surgery. Its major advantages over general anesthesia are the minimization of postoperative apnea risk and the need for ventilatory support [1].The practice of general anesthesia (GA) might have a negative impact regarding those issues.Ultrasound equipment has enabled the development of new anesthetic approaches to neuraxial anesthesia.After obtaining written parental consent to publish, we report the case of an ex-premature infant submitted to supraumbilical abdominal surgery under ultrasound-guided trans-caudal, combined spinal-epidural anesthesia. Fig. 1. Spinal needle piercing the dural sac.