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BackgroundDespite ongoing advances in the field of neonatology, the survival outcomes among critically ill preterm surgical neonates remain unfavorable. Intrahospital transport is one of the major risk factors associated with early mortality (within 30 days) in these newborns. To overcome this, the approach of performing bedside surgeries is being followed. We aim to assess the safety and feasibility of performing bedside neonatal surgeries by analyzing our archives. MethodsThe study focused on retrospective evaluation of all the newborns who have undergone surgical procedures in the neonatal intensive care unit (NICU) at our center from August 2015 through February 2021. Newborns were operated within the NICU if they had very low birth weight or other risk factors making their transport to the operation room risky. The outcomes of surgeries were assessed in terms of postoperative complications, one-month survival, and overall survival. ResultsThirteen children (M:F=9:4) underwent twenty-two surgical procedures. The median (range) gestational age and birth weight of our cohort were 30 (26-36) weeks and 1200 (500-2860) grams, respectively. One-month and overall survival rates in our cohort were 84% (11/13) and 77% (10/13), respectively. No major postoperative complications were observed. The requirement of multiple inotropes and/or high-frequency oscillatory ventilation (HFOV) was the only factor having a significant association with unfavorable survival outcomes. ConclusionsBedside surgery is a safe and feasible alternative to surgeries within the operation room for at-risk newborns. In the present study, the requirement of multiple inotropes and/or HFOV was the only factor significantly associated with early mortality.

Background Renal autotransplantation is a complex procedure involving reimplantation of the renal artery and vein at a different site. Anesthetic management of renal autotransplant is challenging because of associated morbidities and intraoperative hemodynamic changes. Case presentation We present a case of a 14-month-old male who had severe hypertension and cardiomyopathy due to renal artery stenosis. Echocardiography reported dilated left atrium and left ventricle, moderate to severe left ventricular systolic dysfunction, and a left ventricular ejection fraction of 30%. The renal artery and renal vein were anastamosed to the great vessels. Anesthetic management included maintaining normal baseline diastolic pressure, systemic vascular resistance, and preload and avoiding tachycardia. Milrinone infusion was used. Conclusions Anesthetic management was challenging as adequate perfusion pressures had to be maintained while keeping the patient hemodynamically stable.

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