Bedside laparotomy in newborns -A single institute experience

Herle, Koushik; Jayaram, Harish; Deb, Mainak; Bothra, Jyoti; Kannaiyan, Lavanya; Waghmare, Mukta; Krithiga, Abirami

doi:10.1016/j.jpedsurg.2020.11.029

Cited by 5 publications

(12 citation statements)

References 11 publications

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“…It must also be highlighted that the youngest gestational age and minimum birth weight in our cohort were 27 weeks and 500 grams respectively. These findings are similar to a recent study by Herle et al [3].…”

Section: Discussionsupporting

confidence: 94%

“…First introduced by Besag et al [8] in two critically ill extremely low-birthweight neonates, bedside surgery has gained immense popularity since then. At present, this approach has been incorporated into the protocols of few NICUs across the globe [2][3][4][5]. In fact, as per the recent survey of the Italian Society of Pediatric Surgery, bedside NICU surgery was reported by more than 80% of the respondent NICUs [4].…”

Section: Discussionmentioning

confidence: 99%

“…However, the selection criteria in terms of birth weight differ among different NICUs. While some centers follow a cutoff of 1000 grams, others believe newborns with birth weight <1200 grams benefit the most from surgery within the NICU [3][4][5]. We include all newborns with VLBW as candidates for bedside surgery at our center.…”

Section: Discussionmentioning

confidence: 99%

“…Also, newborns on highfrequency oscillatory ventilation (HFOV) and multiple inotropes in the preoperative period require close observation and their transport to OR is very risky. To overcome these, few neonatal intensive care units (NICUs) across the globe have adopted the approach of bedside surgery or surgery within the NICU [2][3][4]. Apart from minor procedures like insertion of intercostal drains, peritoneal dialysis catheters, and establishment of central venous access; major surgeries for patent ductus arteriosus (PDA), perforation peritonitis, intestinal obstruction, strangulated inguinal hernia, gastroschisis, congenital diaphragmatic hernia (CDH), etc.…”

Section: Introductionmentioning

confidence: 99%

“…It has been demonstrated that various unfavorable incidents including hypothermia, displacement of the endotracheal tube, dislodgements of the intravenous lines, etc. can happen during the intra-hospital transfer of these babies [ 2 , 3 ]. Also, newborns on high-frequency oscillatory ventilation (HFOV) and multiple inotropes in the preoperative period require close observation and their transport to OR is very risky.…”

Section: Introductionmentioning

confidence: 99%

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Operating Within the Neonatal Intensive Care Unit: A Retrospective Analysis From a Tertiary Care Center

Anand

Sandlas

Nabar

et al. 2021

Cureus

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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.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Operating Within the Neonatal Intensive Care Unit: A Retrospective Analysis From a Tertiary Care Center

Anand

Sandlas

Nabar

et al. 2021

Cureus

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Current management of surgical neonates: is it optimal or do we need to improve? A national survey of the Italian Society of Neonatology

Costa,

Capolupo,

Bonadies

et al. 2024

Pediatr Surg Int

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Purpose Few guidelines exist for the perioperative management (PM) of neonates with surgical conditions (SC). This study examined the current neonatal PM in Italy. Methods We invited 51 neonatal intensive care units with pediatric surgery in their institution to participate in a web-based survey. The themes included (1) the involvement of the neonatologist during the PM; (2) the spread of bedside surgery (BS); (3) the critical issues concerning the neonatal PM in operating rooms (OR) and the actions aimed at improving the PM. Results Response rate was 82.4%. The neonatologist is involved during the intraoperative management in 42.9% of the responding centers (RC) and only when the surgery is performed at the patient’s bedside in 50.0% of RCs. BS is reserved for extremely preterm (62.5%) or clinically unstable (57.5%) infants, and the main barrier to its implementation is the surgical-anesthesiology team's preference to perform surgery in a standard OR (77.5%). Care protocols for specific SC are available only in 42.9% of RCs. Conclusion Some critical issues emerged from this survey: the neonatologist involvement in PM, the spread of BS, and the availability of specific care protocols need to be implemented to optimize the care of this fragile category of patients.

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Congenital Diaphragmatic Hernia Repair at the Bedside or Operating Theater

Niec

Achey

Wallace

et al. 2022

The American Surgeon™

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Background For critically ill congenital diaphragmatic hernia (CDH) patients on high frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and/or inhaled nitric oxide (iNO), operative repair in the neonatal intensive care unit (NICU) has been proposed to avoid complications during transport to an operating room (OR). This study compared neonates with CDH who received herniorrhaphy in the NICU or OR, with a subgroup analysis considering only patients supported with ECMO. Methods Patients admitted to the NICU in the first 2 weeks of life at a free-standing children’s hospital between July 2004 and September 2021 were examined. Patients were categorized according to location of CDH repair, and impact on operative complications and survival was compared. Results 185 patients were admitted to the NICU with posterolateral CDH and received operative repair. 48 cases were operated on at the bedside in the NICU and 137 in the OR. Patients repaired in the NICU had higher use of HFOV, pulmonary vasodilators, and ECMO (all P < .001). Children repaired in the NICU experienced significantly higher in-hospital death and overall mortality ( P < .001). However, in multivariate analysis, repair location was not a significant predictor of survival to discharge in patients receiving ECMO. No significant difference in surgical site infection was detected for operative location ( P = .773). Discussion Congenital diaphragmatic hernia repair in the NICU occurred more frequently among higher risk patients who experienced worse survival. The rate of surgical site infection appeared similar overall and across subgroups suggesting adequate sterility and technique for bedside procedures, when necessary, despite restricted access to advanced operative equipment.

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Bedside laparotomy in newborns -A single institute experience

Cited by 5 publications

References 11 publications

Operating Within the Neonatal Intensive Care Unit: A Retrospective Analysis From a Tertiary Care Center

Operating Within the Neonatal Intensive Care Unit: A Retrospective Analysis From a Tertiary Care Center

Current management of surgical neonates: is it optimal or do we need to improve? A national survey of the Italian Society of Neonatology

Congenital Diaphragmatic Hernia Repair at the Bedside or Operating Theater

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