Operieren auf der neonatologischen Intensivstation

Abstract

BackgroundSurgical procedures on neonates and preterm infants on the neonatal intensive care unit (NICU) are common practice to avoid potentially hazardous complications during transport to the operating room (OR). So far clear literature-based recommendations for action with respect to the advantages and disadvantages for patients and surgeons are lacking.ObjectiveSummary of the available literature on operating on the NICU and compilation of practical recommendations for action using this approach.Material and methodsReview of the literature, summary and analysis of available data. Recommendations and concept of action based on the literature and experiences of the authors.Results and discussionData on operating on the NICU are limited. Retrospective analyses of case series include up to several hundred patients with a broad spectrum of operative procedures performed on the NICU. Comparative studies have been published on closure of persistent ductus arteriosus (PDA), laparotomy for necrotising enterocolitis (NEC) and repair of congenital diaphragmatic hernia (CDH). Evidence-based advantages for patients as compared to operations in the OR are better respiratory and hemodynamic stability and avoidance of hypothermia. No evidence has been found for a higher risk of perioperative infections. Operating on the NICU is a valid option at least for critically ill neonates and extremely premature infants. Potential disadvantages for surgical and medical teams are confined spaces, poorer lighting conditions and limited surgical equipment. These potential disadvantages should be addressed with a structured operative set-up and adequate anesthesia and surgical equipment. Interdisciplinary consensus, professional cooperation of different subspecialties and team spirit contribute to the success of operating on the NICU.