Are We Enhancing Recovery After Neonatal Surgery? Assessment of Enhanced Recovery After Surgery Principles for Ostomy...

Area of Science:

• Pediatric Surgery
• Critical Care Medicine
• Evidence-Based Medicine

Background:

• Enhanced Recovery After Surgery (ERAS) guidelines improve adult surgical outcomes.
• Neonatal ERAS studies are limited, and guideline translation is challenging.
• Knowledge and practice of neonatal ERAS guidelines remain largely unknown.

Purpose of the Study:

• To determine current practice of 2020 neonatal intestinal surgery ERAS guidelines.
• To evaluate postoperative outcomes associated with ERAS guideline adherence.
• To identify practice gaps in neonatal ERAS implementation.

Main Methods:

• Retrospective study of 186 patients (<1 year) undergoing elective ostomy takedown.
• Development and application of a 13-point ERAS score.
• Analysis of demographics, clinical course, pain management, nutrition, ERAS scores, and outcomes.

Main Results:

• Median ERAS score was 6 (IQR 5-7), indicating poor adherence.
• Highest adherence for prophylactic antibiotics (97.9%), lowest for preventing hypothermia (14.5%) and limiting opioids (9.1%).
• Surgical site infection rate was 14.5%; median length of stay was 28 days.

Conclusions:

• Current institutional practice of neonatal intestinal surgery ERAS guidelines is suboptimal.
• Key areas for improvement include intraoperative hypothermia prevention, opioid limitation, and early enteral feeding.
• Future research will focus on ERAS guideline implementation and outcome evaluation in neonates.