TITLE:
Emergency Surgical Intervention by Mobile Surgical Team in the NICU
AUTHORS:
R.-B. Trobs, A. Stein, U. Felderhoff, L. Hanssler
KEYWORDS:
Off-Site Surgery, NICU, Extremely Low Birth Weight Infants, Necrotizing Enterocolitis, Spontaneous Bowel Perforation, Gastric Perforation
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.4 No.2,
May
30,
2014
ABSTRACT:
The objective of this study was to describe our NICU’s (neonatal intensive care unit) experience with mobile surgical team and to demonstrate its effectiveness. Method: We analyzed the data of 17 consecutive very low birth weight and extremely low birth weight infants over 3 years who underwent 22 procedures (19 emergency and 3 elective). The gestational age at birth was a median of 25 weeks (range 24 - 39), and the median birth weight was 613 g (range from 340 g to 1100 g). The infants received their operations during their first 2 weeks of life (median 7 days, range from 1 to 14). Results: The spectrum of primary surgical diagnoses included spontaneous intestinal perforations (n = 8), gastric perforations (n = 3), necrotizing enterocolitis (n = 2), meconium ileus (n = 2), and miscellaneous (n = 2). An emergency laparotomy with either a bowel or a gastric procedure was performed in 16 cases. Postoperatively, all infants required mechanical ventilation from 1 to 43 days (median 6.5 days). Complications included a metachronous small bowel perforation, an ileostomy retraction, a prolapsed stoma, and impaired wound healing; we had one postoperative death. Two infants died later in the NICU (mortality 3 of 16; 19%). Conclusion: Off-site surgery for preterm infants in the NICU is feasible. This approach prevents the risks of transportation, and parents and neonatologists alike feel comfortable with this regimen. However, biases may exist regarding the surgeon’s decision to operate, the choice of procedure, and the follow-up.