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Overnight observation in former premature infants undergoing inguinal hernia repair
Carrie A Laituri1, Carissa L Garey, Benjamin J Pieters
1Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
Overnight observation for apneic events in former preterm infants undergoing inguinal hernia repair may be safely shortened. Patients under 50 weeks post-conceptional age (PCA) born before 37 weeks gestation showed minimal events, suggesting revised guidelines are possible.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neonatology
Background:
- Overnight observation for apneic events is standard for former preterm infants.
- Current protocols for post-anesthetic observation lack recent supporting literature.
- This study retrospectively evaluates post-anesthetic risks in these patients.
Purpose of the Study:
- To evaluate the necessity of current overnight observation protocols for former preterm infants after inguinal herniorrhaphy.
- To determine if current post-anesthetic observation guidelines can be revised for this patient population.
Main Methods:
- Retrospective review of former preterm infants undergoing inguinal herniorrhaphy (1/00-10/09).
- Inclusion criteria: born before 37 weeks gestation and <60 weeks post-conceptional age (PCA).
- Patients categorized into three PCA groups: <40 weeks, 40-49.9 weeks, and 50-60 weeks.
Main Results:
- 363 patients were analyzed; 4 events (1.1%) occurred in patients <50 weeks PCA.
- Events included spontaneous resolution of apnea and apnea-induced bradycardia.
- No events were observed in patients aged 50-60 weeks PCA.
Conclusions:
- Conservative guidelines for overnight observation after inguinal hernia repair can be considered for patients <50 weeks PCA.
- This suggests a potential reduction in hospital stay for eligible former preterm infants.
- Further research may refine observation protocols based on post-conceptional age.
Background:
Overnight observation for apneic events is standard practice in former preterm infants. However, the literature supporting current protocols is dated. Therefore, we retrospectively evaluated the post-anesthetic risks in these patients.
Methods:
A retrospective review was conducted on former preterm infants admitted after an inguinal herniorrhaphy between 1/00 and 10/09. The protocol for overnight admission was for patients born before 37 weeks gestation who are less than 60 weeks post-conceptional age (PCA).
Results:
There were 363 patients, of which 23 were <40 weeks PCA (group 1), 244 were 40 to 49.9 weeks PCA (group 2), and 96 were 50 to 60 weeks PCA (group 3). Events registered by alarms occurred in 4 patients (1.1%), 2 from group 1 and 2 from group 2. In Group 1, one occurred during nasogastric tube placement and resolved spontaneously. In group 2, one was apnea-induced bradycardia that resolved spontaneously, and one was in a patient on home monitors with an event similar to home reports. There were no events in group 3.
Conclusion:
Conservative guidelines for overnight observation after inguinal hernia repair could be set for patients born before 37 weeks gestation who are under 50 weeks PCA.
