Emergency Surgical Intervention by Mobile Surgical Team in the NICU

R.-B.  Trobs; A.  Stein; U.  Felderhoff; L.  Hanssler

doi:10.4236/ojped.2014.42022

R.-B. Trobs^*, A. Stein, U. Felderhoff, L. Hanssler

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.

Keywords: Off-Site Surgery, NICU, Extremely Low Birth Weight Infants, Necrotizing Enterocolitis, Spontaneous Bowel Perforation, Gastric Perforation

Cite this paper: Trobs, R. , Stein, A. , Felderhoff, U. and Hanssler, L. (2014) Emergency Surgical Intervention by Mobile Surgical Team in the NICU. Open Journal of Pediatrics, 4, 162-168. doi: 10.4236/ojped.2014.42022.

References

[1] Meadow, W., Lee, G., Lin, K. and Lantos, J. (2004) Changes in Mortality for ELBWI in the 1990s. Pediatrics, 113, 1223-1229. http://dx.doi.org/10.1542/peds.113.5.1223

[2] Currie, J.M. (2008) Stress and Pain Relief in the Care of the Surgical Neonate. Seminars in Pediatric Surgery, 17, 285- 289. http://dx.doi.org/10.1053/j.sempedsurg.2008.07.007

[3] Taylor, R.L., Grover, F.L., Harman, P.K., Escobedo, M.K., Ramamurthy, R.S. and Trinkle, J.K. (1986) Operative Closure of Patent Ducus Arteriosus in Premature Infant in the Neonatal Intensive Care Unit. The American Journal of Surgery, 152, 704-708. http://dx.doi.org/10.1016/0002-9610(86)90 453-8

[4] Hubbard, C., Rucker, R.W., Realyvasquez, F., Sperling, D.R., Hicks, D.A., Worcester, C.C., et al. (1986) Ligation of the Patent Ductus Arteriosus in Newborn Respiratory Failure. Journal of Pediatric Surgery, 3-5. http://dx.doi.org/10.1016/S0022-3468(86)80639-X

[5] Finer, N.N., Woo, B.C., Hayashi, A. and Hayes, B. (1993) Neonatal Surgery. Intensive Care Unit versus Operating Room. Journal of Pediatric Surgery, 28, 645-649. http://dx.doi.org/10.1016/0022-3468(93)90021-C

[6] Gordon, P.V., Swanson, J.R., Attridge, J.T. and Clark, R. (2007) Emerging Trends in Acquired Neonatal Intestinal Disease: Is It Time to Abandon Bell’s Criteria. Journal of Perinatology, 27, 661-671. http://dx.doi.org/10.1038/sj.jp.7211782

[7] Gavilanes, A.W.D., Heinemann, E., Herpers, M.J. and Blanco, C.E. (1997) Use of Neonatal Intensive Care Unit as a Safe Place for Neonatal Surgery. Archives of Disease in Childhood, 76, F51-F53. http://dx.doi.org/10.1136/fn.76.1.F51

[8] Henry, M.C.W. and Moss, R.L. (2008) Neonatal Necrotizing Enterocolitis. Seminars in Pediatric Surgery, 17, 98-109. http://dx.doi.org/10.1053/j.sempedsurg.2008.02.005

[9] Gordon, P.V. and Attridge, J.T. (2009) Understanding Clinical Literature Relevant to Spontaneous Intestinal Perforations. American Journal of Perinatology, 26, 309-316. http://dx.doi.org/10.1055/s-0028-1103514

[10] Rees, C.M., Pierro, A. and Eaton, S. (2007) Neurodevelopmental Outcomes of Neonates with Medically and Surgically Treated Necrotizing Enterocolitis. Archives of Disease in Childhood. Fetal and Neonatal Edition, 92, F193-F198. http://dx.doi.org/10.1136/adc.2006.099929

[11] Fanning, N.F., Casey, W. and Corbally, M.T. (1998) In-Situ Emergency Paediatric Surgery in the Intensive Care Unit. Pediatric Surgery International, 13, 587-589.
http://dx.doi.org/10.1007/s003830050410

[12] Ein, S.H., Marshall, D.G. and Girvan, D. (1977) Peritoneal Drainage under Local Anesthesia for Perforations from Necrotizing Enterocolitis. Journal of Pediatric Surgery, 12, 963-967.
http://dx.doi.org/10.1016/0022-3468(77)90607-8

[13] Leone, R.J. and Krasna, I.H. (2000) “Spontaneous” Neonatal Gastric Perforation: Is It Really Spontaneous? Journal of Pediatric Surgery, 35, 1066-1069.
http://dx.doi.org/10.1053/jpsu.2000.7773