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Laparotomy for necrotizing enterocolitis: intensive care nursery compared with operating theatre
G Frawley1, G Bayley, P Chondros
1Department of Anaesthesia, Royal Children's Hospital, Parkville, Victoria, Australia. frawleyg@cryptic.rch.unimelb.edu.au
Journal of Paediatrics and Child Health
|July 15, 1999
Summary
Performing surgery for necrotizing enterocolitis (NEC) in the neonatal intensive care unit (NICU) is safer for neonates under 1500g. Transferring these infants to the operating room (OR) is linked to physiological deterioration and potential harm.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Critical care medicine
Background:
- Necrotizing enterocolitis (NEC) is a severe gastrointestinal condition in neonates.
- Surgical intervention (laparotomy) is often required for severe NEC.
- The optimal location for performing surgery on these vulnerable infants is debated.
Purpose of the Study:
- To compare perioperative stability and physiological disruption in neonates undergoing laparotomy for NEC.
- To evaluate outcomes based on surgical location: neonatal intensive care unit (NICU) versus operating theatre (OR).
Main Methods:
- Retrospective case review of 233 neonates with severe NEC (1989-1997).
- Comparison of mortality and morbidity using the Score for Neonatal Acute Physiology (SNAP).
- Analysis of 36 physiological variables pre- and postoperatively.
Main Results:
- Mortality in neonates <1500g was associated with illness severity (SNAP), not surgical location.
- Transfer to the OR correlated with hypothermia, worsened oxygenation, ventilation, and platelet counts.
- Extensive perioperative resuscitation may have masked some adverse effects.
Conclusions:
- Surgery for severe NEC in neonates <1500g can be safely performed in the NICU.
- Encouraging NICU-based surgery for these infants is warranted.
- Transport to the OR for laparotomy is linked to significant physiological decline, potentially increasing morbidity.