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.
Highlights
In many centers, “in-situ surgery” (ISS) in the neonatal intensive care unit (NICU) is selected for specific emergency procedures on critically ill and unstable neonates
In cases with a high probability for intervention, a team consisting of a surgeon, a pediatric surgical resident, a scrub nurse, and an assistant nurse were sent to the NICU
Four infants were from two twin births, and two were from a triplet birth
Summary
“in-situ surgery” (ISS) in the neonatal intensive care unit (NICU) is selected for specific emergency procedures on critically ill and unstable neonates. It is performed on the incubator without transporting the baby outside. Our goal was to examine the benefits and limitations of OSS in an NICU located 20 km from the pediatric surgery department within a congested area. This surgery was performed to provide a pediatric surgical care service for the NICU, which lacks its own pediatric surgery department. Surgery under the described circumstances was performed transitionally until the introduction of a high quality local neonatal surgery service
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