Enhanced Recovery After Surgery (ERAS) Society Recommendations for Neonatal Perioperative Care

Area of Science:

• Neonatal surgery
• Evidence-based medicine
• Perioperative care

Background:

• Neonates requiring surgery are typically managed in neonatal intensive care units (NICUs).
• Despite diverse surgical conditions, common perioperative priorities exist for neonates.
• These shared priorities enable the creation of unit-wide Enhanced Recovery After Surgery (ERAS) recommendations.

Purpose of the Study:

• To develop evidence-based Enhanced Recovery After Surgery (ERAS) guidelines for neonates admitted to NICUs.
• To establish unit-wide recommendations applicable to diverse surgical pathologies in neonates.
• To standardize and improve perioperative care for surgical neonates.

Main Methods:

• A multidisciplinary guideline development committee was formed, including pediatric surgeons, anesthesiologists, neonatal nurses, neonatologists, and ERAS experts.
• A modified Delphi technique identified 42 potential topics, with consensus for 21 topic areas.
• Systematic literature review screened 5763 abstracts, including 98 full-text articles, to formulate 16 recommendations across 11 topic areas.

Main Results:

• Developed 16 evidence-based recommendations for neonatal perioperative care within NICUs.
• Key recommendation areas include team communication, preoperative fasting, temperature regulation, antibiotic prophylaxis, ventilation, fluid management, glucose control, transfusion thresholds, enteral feeds, and parental support.
• Insufficient data precluded recommendations on nasogastric tubes, Foley catheters, and central lines.

Conclusions:

• Neonatal perioperative care in NICUs allows for the development of standardized ERAS recommendations, irrespective of surgical procedure.
• The 16 developed ERAS recommendations are designed for implementation in NICUs to benefit all neonates undergoing surgery.
• These guidelines aim to optimize outcomes for surgical neonates through evidence-based practices.