BACKGROUND: Babies born with extreme prematurity and low birth weight (< 1000 g) present a unique treatment challenge. In addition to the complexity of achieving survival, they may require surgical interventions for abdominal emergencies. Usually, these infants are transferred to a referral center for surgical treatment. Since 2000 our approach is bedside abdominal surgery at the referring center. OBJECTIVES: To evaluate whether the approach of bedside abdominal surgery at the referring center is safe and perhaps even beneficial for the baby. METHODS: We retrospectively reviewed our data since 2000 and included only babies weighing < 1000 g who were ventilated, suffered from hemodynamic instability, and underwent surgery for perforated bowel at the referring neonatal unit. Results were analyzed according to survival from the acute event (> 1 week), survival from the abdominal disease (> 30 days), and survival to discharge. RESULTS: Twelve babies met the inclusion criteria. Median weight at operation was 850 g (range 620-1000 g) and median age at birth was 25 weeks (range 23-27). Eleven infants survived the acute event (91.7%), 9 survived more than 30 days (81.8%), and 5 survived to discharge. CONCLUSIONS: Our results show that bedside laparotomy at the referring hospital is safe and feasible. A larger randomized study is indicated to prove the validity of this approach.
BACKGROUND: Babies born with extreme prematurity and low birth weight (< 1000 g) present a unique treatment challenge. In addition to the complexity of achieving survival, they may require surgical interventions for abdominal emergencies. Usually, these infants are transferred to a referral center for surgical treatment. Since 2000 our approach is bedside abdominal surgery at the referring center. OBJECTIVES: To evaluate whether the approach of bedside abdominal surgery at the referring center is safe and perhaps even beneficial for the baby. METHODS: We retrospectively reviewed our data since 2000 and included only babies weighing < 1000 g who were ventilated, suffered from hemodynamic instability, and underwent surgery for perforated bowel at the referring neonatal unit. Results were analyzed according to survival from the acute event (> 1 week), survival from the abdominal disease (> 30 days), and survival to discharge. RESULTS: Twelve babies met the inclusion criteria. Median weight at operation was 850 g (range 620-1000 g) and median age at birth was 25 weeks (range 23-27). Eleven infants survived the acute event (91.7%), 9 survived more than 30 days (81.8%), and 5 survived to discharge. CONCLUSIONS: Our results show that bedside laparotomy at the referring hospital is safe and feasible. A larger randomized study is indicated to prove the validity of this approach.
Authors: N J Hall; M P Stanton; L J Kitteringham; R A Wheeler; D M Griffiths; M Drewett; D M Burge Journal: Pediatr Surg Int Date: 2012-08-21 Impact factor: 1.827