Neonatal bedside laparotomy in the UK: a multidisciplinary survey of practice and perceptions

Emergency neonatal laparotomy can be undertaken on the intensive care unit (ICU) or in the operating theatre. The evidence-base establishing indications, benefits or disadvantages is limited. We conducted a multidisciplinary survey of UK neonatal surgical centres to describe current practice.

A 16-item online survey was developed, and responses sought from one anaesthetist, one neonatologist and one surgeon at each of the 25 neonatal surgery centres in the UK. Quantitative responses were analysed with descriptive statistics (IBM SPSS Statistics v30). Free-text responses were subjected to qualitative thematic analysis.

23 anaesthetists, 23 neonatologists, and 23 paediatric surgeons responded (69/75; 92%). At least one response was received from every centre. Cotside laparotomy is carried out in 22 (88%) of centres. 44 (64%) respondents preferred operating in theatre although a significant minority favoured cotside surgery (13 (19%)). Only 5 (20%) centres reported having formal indications for cotside laparotomy. Centres with established pathways performed a significantly higher proportion of cotside laparotomies compared to centres without established guidelines (p < 0.001). Factors influencing decision to operate at the cotside were patient-specific: cardiovascular instability (86%), ventilator dependence (70%) and low birthweight (42%). 46 (67%) respondents recalled complications associated with theatre-based operating including hypothermia (41%), airway complications (15%) and cardiovascular instability (10%). Respondents perceived bedside surgery to be constrained by limited space (62%), disturbance to NICU families and staff (56%) and lack of neonatal surgical instruments (49%).

This study establishes the first UK dataset on location of neonatal laparotomy, revealing marked variation in practice based on institutional preference, signalling need for national guideline development.