Bedside laparotomy in newborns -A single institute experience

Area of Science:

• Neonatal surgery
• Pediatric surgery
• Critical care medicine

Background:

• Intra-hospital transfer of critically ill newborns poses significant risks.
• Bedside interventions can mitigate the need for transport and associated complications.
• This study reports single-institute experience with bedside laparotomies in unstable neonates.

Purpose of the Study:

• To evaluate the feasibility and outcomes of bedside laparotomy in unstable neonates.
• To compare outcomes of neonates undergoing bedside surgery versus conventional operating room surgery.
• To assess the safety and efficacy of performing surgical interventions at the patient's bedside.

Main Methods:

• Retrospective comparative study analyzing seven-year electronic medical records.
• Group A: 28 neonates undergoing bedside laparotomy for intra-abdominal sepsis (NEC, SIP, meconium ileus, atresias).
• Group B: 60 neonates undergoing conventional surgery for similar indications.

Main Results:

• Bedside group (A) had lower weight at surgery (1098g vs 1872g) and higher rates of inotropic support (78% vs 20%) and HFOV (50% vs 0%).
• Higher incidence of NEC Totalis in Group A (7/28 vs 1/60).
• Survival rates were significantly lower in Group A (25%) compared to Group B (76.67%), attributed to higher patient acuity.

Conclusions:

• Bedside laparotomy is a viable option for unstable neonates unsuitable for transport.
• This approach can be life-saving in select critically ill infants.
• Careful patient selection and management are crucial for optimizing outcomes.