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Damage control surgery in neonates: Lessons learned from the battlefield.
G Suren Arul1, Michael Singh1, Afeda Mohammed Ali2
1Department of Surgery, Birmingham Children's Hospital.
Journal of Pediatric Surgery
|May 20, 2019
Summary
Damage control surgery (DCS) in neonates with surgical emergencies showed a low mortality rate of 15%. This approach avoided stomas in most cases, offering a promising strategy for critically ill infants.
Area of Science:
- Neonatal surgery
- Surgical critical care
- Pediatric surgery
Background:
- Mortality remains high for neonates requiring surgery for conditions like necrotizing enterocolitis (NEC).
- Damage control surgery (DCS), a strategy from trauma care, addresses physiological derangements (acidosis, hypothermia, coagulopathy) by prioritizing life over complete initial repair.
- DCS is increasingly used in adult non-trauma surgical emergencies.
Purpose of the Study:
- To describe the experience and outcomes of using DCS in neonates with serious abdominal pathologies.
- To evaluate the effectiveness of DCS in reducing mortality and complications in this vulnerable population.
Main Methods:
- A prospective case series of 27 neonates undergoing DCS between 2010 and 2017.
- Data collected included preoperative physiology, surgical procedure details, and postoperative outcomes.
- The study involved resection of compromised bowel, ligation of ends, and an open abdomen, with a planned second-look surgery.
Main Results:
- 27 neonates (median age 21 days, 29 weeks gestation) underwent DCS, primarily for NEC (23 cases).
- Preoperative physiological derangements were common, with 19 patients operated on in the intensive care unit.
- Overall mortality was 15% (4/27), with 18% in the NEC group. One anastomotic leak and three stomas were reported.
Conclusions:
- DCS in neonates with physiological derangement resulted in low mortality and avoided stomas in most patients.
- This approach warrants further investigation for its efficacy in pediatric non-trauma abdominal catastrophes.
- The study suggests DCS is a viable strategy for critically ill neonates requiring emergency abdominal surgery.
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