Laparotomy for necrotizing enterocolitis: Intensive care nursery compared with operating theatre

Abstract

The use of the neonatal intensive care nursery for surgery on neonates weighing less than 1500 g with severe NEC can be justified and such use should be encouraged. In contrast, secondary transport of neonates weighing less than 1500 g to the OR for laparotomy is associated with significant deterioration in a number of physiological parameters, which may impact on morbidity.

Making decisions for surgical intervention in neonates with necrotizing enterocolitis and the selection of appropriate surgical intervention

“…However, Frawley et al carries out all surgery on NEC infants under 1500 grams in the neonatal intensive care unit, and reports a mortality rate of 33% [17]. Hall et al report that they routinely intubate, ventilate and operate on all neonates in the neonatal intensive care unit [18].…”

Where should we operate on the preterm neonate?

“…Data indicating that outcomes are worse if infants with necrotizing enterocolitis are transferred for surgery, rather than operated on in the NICU, may be dismissed as being rather historical but very recent data from Michigan examining transports of very low birth weight (VLBW) infants, that is, <1500 g, using a previously validated transport risk index of physiologic stability (‘TRIPS’), confirm the previous historical findings of real deterioration in these infants . This latter study identified that increased transport times of only greater than 15 min were associated with increased morbidity.…”

“…For some years now, there has been a controversy concerning the best site to perform operations in sick and unstable neonates . The challenge still remains for a surgical team to perform a matched control study as this has not been achieved to date.…”

“…The challenge still remains for a surgical team to perform a matched control study as this has not been achieved to date. Series reported in the literature tend to identify two separate populations; one of larger infants, more easily transportable, less sick, with less respiratory compromise versus a smaller, sicker group with a higher prevalence of more difficult ventilation .…”

Anästhesiologische Aspekte in der Neu- und Frühgeborenenchirurgie

“…Es scheint vorteilhaft, wenn es die lokale Logistik erlaubt, extrem unreife oder schwer kranke Kinder nicht zu transportieren, sondern sie auf der Intensivstation zu operieren. Es konnte allerdings kein Unterschied in der Mortalität gezeigt werden [27]. Transporte in den Operationssaal sind v. a. mit ausgeprägteren Hypothermien [4], Operationen an der Intensivstation wahrscheinlich mit mehr Infektionskomplikationen verbunden [40].…”