Surgery in the Neonatal Intensive Care Unit: Current Practices and Perspectives of Pediatric Surgeons in Germany

Surgery in the neonatal intensive care unit has become a standard practice for critically ill premature and newborn infants, minimizing the risks associated with patient transport to the operating theater. This study aimed to assess the current practice, challenges, and working conditions of pediatric surgeons performing surgery in the neonatal intensive care unit, based on a nationwide survey in Germany.

A nationwide survey was conducted among members of the German Society of Pediatric Surgery, exploring surgeons' opinions about operating in the neonatal intensive care unit, including patients' conditions, environmental factors, technical needs, and logistic challenges. Ethical approval was obtained.

Fifty pediatric surgeons completed the survey. The most decisive factors influencing the decision to operate in the neonatal intensive care unit were the patient's non-transportability (100%) and cardiorespiratory instability (98%). Exploratory laparotomy was the most frequent procedure. Surgeons valued the direct communication with neonatologists (86% satisfaction), but identified relevant environmental concerns as inadequate lighting (98%), poor temperature regulation (94%), and limited working space (70%). Nonetheless, 88% of respondents considered the neonatal intensive care unit surgery as both safe and clinically effective, while 60% reported the absence of standardized protocols.

Surgery in the neonatal intensive care unit is feasible and often preferred for critically ill neonates in Germany, yet improvements in ergonomics, environment and standardized procedural protocols remain essential.