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Gaiduchevici AE, Cîrstoveanu CG, Socea B, Bizubac AM, Herișeanu CM, Filip C, Mihălțan FD, Dimitriu M, Jacotă-Alexe F, Ceaușu M, Spătaru RI. Neonatal intensive care unit on-site surgery for congenital diaphragmatic hernia. Exp Ther Med 2022; 23:436. [PMID: 35607371 PMCID: PMC9121203 DOI: 10.3892/etm.2022.11363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
The present study presents the experience gained in the Newborn Intensive Care Unit (NICU) of 'Maria S. Curie' Emergency Clinical Hospital for Children in Bucharest (Romania) after performing a series of bedside surgery interventions on newborns with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis of the data for all patients operated on-site between 2011 and 2020, in terms of pre- and post-operative stability, procedures performed, complications and outcomes. An analysis of a control group was used to provide a reference to the survival rate for non-operated patients. The present study is based on data from 10 cases of newborns, surgically operated on, on average, on the fifth day of life. The main reasons for operating on-site included hemodynamical instability and the need to administer inhaled nitric oxide (iNO) and high-frequency oscillatory ventilation (HFOV). There were no unforeseen events during surgery, no immediate postoperative complications and no surgery-related mortality. One noticed drawback was the unfamiliarity of the surgery team with the new operating environment. Our experience indicates that bedside surgery improves the likelihood of survival for critically ill neonates suffering from CDH. No immediate complications were associated with this practice.
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Affiliation(s)
- Alina Elena Gaiduchevici
- Neonatal Intensive Care Unit, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
| | - Cătălin Gabriel Cîrstoveanu
- Neonatal Intensive Care Unit, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
- Discipline of Pediatrics, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, ‘Sf. Pantelimon’ Emergency Clinical Hospital, 021659 Bucharest, Romania
- Discipline of Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ana Michaela Bizubac
- Neonatal Intensive Care Unit, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
| | - Carmen Mariana Herișeanu
- Neonatal Intensive Care Unit, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
| | - Cristina Filip
- Department of Cardiology, ‘Maria S. Curie’ Emergency Clinic Hospital for Children, 077120 Bucharest, Romania
| | - Florin Dumitru Mihălțan
- Department of Pneumology, ‘Marius Nasta’ National Institute of Pneumology, 050159 Bucharest, Romania
- Discipline of Pneumology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihai Dimitriu
- Department of Obstetrics and Gynecology, ‘Sf. Pantelimon’ Emergency Hospital, 021659 Bucharest, Romania
- Discipline of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florentina Jacotă-Alexe
- Department of Obstetrics and Gynecology, ‘Sf. Pantelimon’ Emergency Hospital, 021659 Bucharest, Romania
| | - Mihail Ceaușu
- Department of Histopathology, ‘Alexandru Trestioreanu’ National Institute of Oncology, 022328 Bucharest, Romania
- Discipline of Histopathology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu-Iulian Spătaru
- Department of Pediatric Surgery, ‘Maria S. Curie’ Emergency Clinical Hospital for Children, 077120 Bucharest, Romania
- Discipline of Pediatric Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Operieren auf der neonatologischen Intensivstation. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herle K, Jayaram H, Deb M, Bothra J, Kannaiyan L, Waghmare M, Krithiga AJ. Bedside laparotomy in newborns -A single institute experience. J Pediatr Surg 2021; 56:2215-2218. [PMID: 33334555 DOI: 10.1016/j.jpedsurg.2020.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE Intra hospital transfer of sick newborns is known to cause adverse events with potential morbidity. Interventions at the bedside in a sick neonate can reduce the need for transport and in turn, potential hazards of transfer. Our single institute experience of performing bedside laparotomies in unstable newborns is reported here. MATERIALS AND METHODS Seven-year data was collected from electronic medical records. This was a retrospective comparative study with level III evidence. Twenty-eight neonates operated at bedside for intraabdominal sepsis due to Necrotising Enterocolitis (NEC), Spontaneous Intestinal Perforation (SIP), complicated meconium ileus and perforation secondary to atresias were included Group A. Group B had 60 neonates operated for similar indications in the conventional operation theatres. RESULTS The average corrected gestational age at surgery, associated co-morbidities, average volume of blood loss and duration of surgery were compared between the groups. Group A had lower weight at surgery (1098 vs 1872 gs), greater percentage of neonates on inotropic support (78% vs 20%) with requirement of High Frequency Ventilation (HFO) (50% vs none). A quarter of neonates (7 of 28) in Group A had NEC Totalis as against only one case in group B. There was 25% survival in group A and 76.67% in group B. The lower survival in group A can be attributed to lower weight at surgery, higher inotrope requirement and need for unconventional modes of ventilation. CONCLUSION Bedside laparotomy is a feasible option in unstable neonates deemed unsuitable for transport.
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Affiliation(s)
- Koushik Herle
- Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India
| | - Harish Jayaram
- Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India
| | - Mainak Deb
- Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India.
| | - Jyoti Bothra
- Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India
| | - Lavanya Kannaiyan
- Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India
| | - Mukta Waghmare
- Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India
| | - Abirami J Krithiga
- Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India
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Anand S, Sandlas G, Nabar N, Joshi P, Terdal M, Suratkal S. Operating Within the Neonatal Intensive Care Unit: A Retrospective Analysis From a Tertiary Care Center. Cureus 2021; 13:e16077. [PMID: 34345557 PMCID: PMC8324603 DOI: 10.7759/cureus.16077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/05/2022] Open
Abstract
Background Despite ongoing advances in the field of neonatology, the survival outcomes among critically ill preterm surgical neonates remain unfavorable. Intrahospital transport is one of the major risk factors associated with early mortality (within 30 days) in these newborns. To overcome this, the approach of performing bedside surgeries is being followed. We aim to assess the safety and feasibility of performing bedside neonatal surgeries by analyzing our archives. Methods The study focused on retrospective evaluation of all the newborns who have undergone surgical procedures in the neonatal intensive care unit (NICU) at our center from August 2015 through February 2021. Newborns were operated within the NICU if they had very low birth weight or other risk factors making their transport to the operation room risky. The outcomes of surgeries were assessed in terms of postoperative complications, one-month survival, and overall survival. Results Thirteen children (M:F=9:4) underwent twenty-two surgical procedures. The median (range) gestational age and birth weight of our cohort were 30 (26-36) weeks and 1200 (500-2860) grams, respectively. One-month and overall survival rates in our cohort were 84% (11/13) and 77% (10/13), respectively. No major postoperative complications were observed. The requirement of multiple inotropes and/or high-frequency oscillatory ventilation (HFOV) was the only factor having a significant association with unfavorable survival outcomes. Conclusions Bedside surgery is a safe and feasible alternative to surgeries within the operation room for at-risk newborns. In the present study, the requirement of multiple inotropes and/or HFOV was the only factor significantly associated with early mortality.
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Affiliation(s)
- Sachit Anand
- Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - Gursev Sandlas
- Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - Neha Nabar
- Neonatology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - Preetha Joshi
- Neonatology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - Mohan Terdal
- Anaesthesiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - Shaila Suratkal
- Neonatology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
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Garge S, Kakani N, Khan J. Surgery in the Neonatal Intensive Care Unit in Indian Scenario: Should It be "The New State of the Art" or Just "The Need of the Hour"? J Indian Assoc Pediatr Surg 2020; 25:368-371. [PMID: 33487939 PMCID: PMC7815018 DOI: 10.4103/jiaps.jiaps_165_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/28/2019] [Accepted: 04/20/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction: Critically ill surgical neonates are physiologically challenged and delicately poised on ventilator and inotropic support systems. They experience significant stress in the event of surgery. Shifting them poise further addition to this stress. We here share our experience of operating such surgical neonates for certain conditions in the neonatal intensive care unit (NICU). Methods: We retrospectively analyzed the data of operated patients in the NICU. We collected the demographic data, diagnosis, and preoperative stability of the patient, ventilator and inotropic requirements, need for extra anesthetic drugs, procedures performed, complications, and outcome. Operations were performed at bedside in the NICU in critically ill, unstable neonates who needed emergency surgery, neonates of very low birth weight (<1000 g), and neonates on special equipment such as high-frequency ventilators. We excluded minor routine procedures such as drain placement, central line placement, ventricular taps, incision and drainage, and intercostal drainage procedures. Results: We performed seven surgical procedures in the NICU. These included bowel resections and stoma creation, fistula ligation, lung biopsies, and ventricular reservoir placement. Gestational age ranged between 24 and 34 weeks (mean, 28 weeks). Birth weights ranged between 800 and 2500 g (mean, 1357 g). Age at surgery was between 2 and 18 days (mean, 10.2 days). All our patients were on inotropic support and were intubated and mechanically ventilated. Conclusion: Doing surgery for critically ill neonates in the NICU definitely has a place. It was the need of the hour based on the condition of the neonates; however, we feel that neonatal surgery in the NICU should be the norm as it can improve survival. Surgery in the NICU can give a fighting chance to these patients; however, operation theaters in the NICU would be an ideal setting.
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Affiliation(s)
- Saurabh Garge
- Department of General Surgery, Pediatric Surgery Unit, Amaltas Institute of Medical Sciences, Dewas, Madhya Pradesh, India
| | - Neha Kakani
- Department of Pediatrics, Amaltas Institute of Medical Sciences, Dewas, Madhya Pradesh, India
| | - Jafar Khan
- Indore Newborn Care Centre, Indore, Madhya Pradesh, India
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Pelizzo G, Bagolan P, Morini F, Aceti M, Alberti D, Andermarcher M, Avolio L, Bartoli F, Briganti V, Cacciaguerra S, Camoglio FS, Ceccarelli P, Cheli M, Chiarenza F, Ciardini E, Cimador M, Clemente E, Cozzi DA, Dall' Oglio L, De Luca U, Del Rossi C, Esposito C, Falchetti D, Federici S, Gamba P, Gentilino V, Mattioli G, Martino A, Messina M, Noccioli B, Inserra A, Lelli Chiesa P, Leva E, Licciardi F, Midrio P, Nobili M, Papparella A, Paradies G, Piazza G, Pini Prato A, Rossi F, Riccipetitoni G, Romeo C, Salerno D, Settimi A, Schleef J, Milazzo M, Calcaterra V, Lima M. Bedside surgery in the newborn infants: survey of the Italian society of pediatric surgery. Ital J Pediatr 2020; 46:134. [PMID: 32938472 PMCID: PMC7493058 DOI: 10.1186/s13052-020-00889-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction This is the report of the first official survey from the Italian Society of Pediatric Surgery (ISPS) to appraise the distribution and organization of bedside surgery in the neonatal intensive care units (NICU) in Italy. Methods A questionnaire requesting general data, staff data and workload data of the centers was developed and sent by means of an online cloud-based software instrument to all Italian pediatric surgery Units. Results The survey was answered by 34 (65%) out of 52 centers. NICU bedside surgery is reported in 81.8% of the pediatric surgery centers. A lower prevalence of bedside surgical practice in the NICU was reported for Southern Italy and the islands than for Northern Italy and Central Italy (Southern <Northern<Central, p < 0.03). The most frequent clinical characteristics of neonates was preterm neonates with birthweight < 1200 g, with cardiorespiratory instability and/or ventilatory dependence. The most frequently selected indications to surgery were pneumothorax, pleural effusion, pericardial effusion, central venous catheter (CVC) positioning, intestinal perforation, patent ductus arteriosus ligation and congenital diaphragmatic hernia. More than 60% of respondents report no institutional recommendations and dedicated informed consent on bedside surgical procedures. The lack of dedicated areas and infrastructures is considered a relative contraindication to the performance of bedside surgery. Conclusion Bedside surgery is performed in the majority of the Italian pediatric surgery centers included in this census. The introduction of a national set of surgery guidelines would be widely welcomed.
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Affiliation(s)
- Gloria Pelizzo
- Department of Paediatric Surgery, Ospedale dei Bambini "V. Buzzi" Children's Hospital, University of Milano, Milano, Italy.
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Daniele Alberti
- Department of Pediatric Surgery, Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Luigi Avolio
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Fabio Bartoli
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | - Vito Briganti
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | - Maurizio Cheli
- Department of Pediatric Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Enrico Ciardini
- Pediatric Surgery Unit, Ospedale Santa Chiara, Trento, Italy
| | - Marcello Cimador
- Pediatric Urology Unit, Department PRO.MI.SE, University of Palermo, Palermo, Italy
| | - Ennio Clemente
- Pediatric Surgery Unit, University of Salerno, Salerno, Italy
| | - Denis A Cozzi
- Department of Pediatrics, Sapienza University, Rome, Italy
| | - Luigi Dall' Oglio
- Digestive Endoscopy and Surgery Unit, Bambino Gesu Children's Hospital-IRCCS, Rome, Italy
| | - Ugo De Luca
- Day Surgery Unit, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Carmine Del Rossi
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II Hospital, University of Naples, Naples, Italy
| | - Diego Falchetti
- Pediatric Surgery Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | | | - Valerio Gentilino
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, Varese, Italy
| | - Girolamo Mattioli
- Department of Pediatric Surgery, G. Gaslini Children's Hospital, University of Genoa, Genoa, Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnico delle Marche University, Ancona, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Alessandro Inserra
- Surgical Oncology Unit, Department of Surgery, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Paola Midrio
- Pediatric Surgery, Ca' Foncello Hospital, Treviso, Italy
| | - Maria Nobili
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | - Alfonso Papparella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giuseppe Piazza
- Pediatric Surgery Unit, Sant'Antonio Abate Hospital, Trapani, Italy
| | - Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Rossi
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità , Novara, Italy
| | - Giovanna Riccipetitoni
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Carmelo Romeo
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Messina, Italy
| | - Domenico Salerno
- Pediatric Surgery Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Alessandro Settimi
- Pediatric Surgery Unit, Federico II Hospital, University of Naples , Naples, Italy
| | - Jurgen Schleef
- Department of Pediatric Surgery, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Mario Milazzo
- Pediatric Surgery Unit, Ospedale del Bambini "G. Di Cristina", ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia and Pediatric Unit V. Buzzi Children's Hospital, Milan, Italy
| | - Mario Lima
- Department of Pediatric Surgery, University of Bologna, Bologna, Italy
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Catania VD, Boscarelli A, Lauriti G, Morini F, Zani A. Risk Factors for Surgical Site Infection in Neonates: A Systematic Review of the Literature and Meta-Analysis. Front Pediatr 2019; 7:101. [PMID: 30984722 PMCID: PMC6449628 DOI: 10.3389/fped.2019.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/05/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose: Surgical site infections (SSI) contribute to postoperative morbidity and mortality in children. Our aim was to evaluate the prevalence and identify risk factors for SSI in neonates. Methods: Using a defined strategy, three investigators searched articles on neonatal SSI published since 2000. Studies on neonates and/or patients admitted to neonatal intensive care unit following cervical/thoracic/abdominal surgery were included. Risk factors were identified from comparative studies. Meta-analysis was conducted according to PRISMA guidelines using RevMan 5.3. Data are (mean ± SD) prevalence. Results: Systematic review-of 885 abstracts screened, 48 studies (27,760 neonates) were included. The incidence of SSI was 5.6% (1,564 patients). SSI was more frequent in males (61.8%), premature babies (77.4%), and following gastrointestinal surgery (95.4%). Meta-analysis-10 comparative studies (16,442 neonates; 946 SSI 5.7%) showed that predictive factors for SSI development were gestational age, birth weight, age at surgery, length of surgical procedure, number of procedure per patient, length of preoperative hospital stay, and preoperative sepsis. Conversely, preoperative antibiotic use was not significantly associated with development of SSI. Conclusions: Younger neonates and those undergoing abdominal procedures are at higher risk for SSI. Given the lack of evidence-based literature, prospective studies may help determine the risk factors for SSI in neonates.
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Affiliation(s)
- Vincenzo Davide Catania
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Alessandro Boscarelli
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppe Lauriti
- Department of Pediatric Surgery, Spirito Santo Hospital and G. d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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A comparison of postoperative outcomes with PDA ligation in the OR versus the NICU: a retrospective cohort study on the risks of transport. BMC Anesthesiol 2018; 18:199. [PMID: 30579349 PMCID: PMC6303951 DOI: 10.1186/s12871-018-0658-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 12/03/2018] [Indexed: 12/04/2022] Open
Abstract
Background Although patent ductus arteriosus (PDA) ligations in the Neonatal Intensive Care Unit (NICU) have been an accepted practice, many are still performed in the Operating Room (OR). Whether avoiding transport leads to improved perioperative outcomes is unclear. Here we aimed to determine whether PDA ligations in the NICU corresponded to higher risk of surgical site infection or mortality and if transport was associated with worsened perioperative outcomes. Methods We performed a retrospective cohort study of NICU patients, ≤37 weeks post-menstrual age, undergoing surgical PDA ligation in the NICU or OR. We excluded any infants undergoing device PDA closure. We measured the incidence of perioperative hypothermia, cardiac arrest, decreases in SpO2, hemodynamic instability and postoperative surgical site infection, sepsis and mortality. Results Data was collected on 189 infants (100 OR, 89 NICU). After controlling for number of preoperative comorbidities, weight at time of procedure, procedure location and hospital in the mixed-effect model, no significant difference in mortality or sepsis was found (odds ratio 0.31, 95%CI 0.07, 1.30; p = 0.107, and odds ratio 0.40; 95%CI 0.14, 1.09; p = 0.072, respectively). There was an increased incidence of hemodynamic instability on transport postoperatively in the OR group (12.4% vs 2%, odds ratio 6.93; 95% CI 1.48, 35.52; p = 0.014). Conclusion PDA ligations in the NICU were not associated with higher incidences of surgical site infection or mortality. There was an increased incidence of hemodynamic instability in the OR group on transport back to the NICU. Larger multicenter studies following long-term outcomes are needed to evaluate the safety of performing all PDA ligations in the NICU. Keywords Patent ductus arteriosus, Newborn infant, Neonatal intensive care unit, Surgical wound infection, Postoperative period, Hemodynamics
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He ZR, Lin TI, Ko PJ, Tey SL, Yeh ML, Wu HY, Wu CY, Yang YCS, Yang SN, Yang YN. The beneficial effect of air cleanliness with ISO 14644-1 class 7 for surgical intervention in a neonatal intensive care unit: A 10-year experience. Medicine (Baltimore) 2018; 97:e12257. [PMID: 30200161 PMCID: PMC6133589 DOI: 10.1097/md.0000000000012257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Whether critically ill neonates needing a surgical intervention should be transferred to an operating room (OR) or receive the intervention in a neonatal intensive care unit (NICU) is controversial. In this study, we report our experience in performing surgical procedures in a NICU including air cleanliness.This was a retrospective study performed at a metropolitan hospital. The charts of all neonates undergoing surgical procedures in the NICU and OR were retrospectively reviewed from January 2007 to June 2017. Data on baseline characteristics, procedure and duration of surgery, ventilator use, hypothermia, instrument dislocations, surgery-related infections and complications, and outcomes were analyzed.Ninety-two neonates were enrolled in this study, including 44 in the NICU group and 48 in the OR group. The air cleanliness was International Organization for Standardization (ISO) 14644-1 class 7 in the NICU and class 5-6 in the OR. The NICU group had a younger gestational age and lower birth body weight than the OR group. The OR group had a higher incidence of hypothermia than in the NICU group (56.3% vs 9.1%, P < .001). However, there were no significant differences in surgical site related infections or mortality between the 2 groups.This study suggests that performing surgical procedures in a NICU with air cleanliness class 7 is as safe as in an OR, as least in part, when performing patent ductus arteriosus ligation and exploratory laparotomy.
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Affiliation(s)
- Zong-Rong He
- Department of Pediatrics, E-DA Hospital
- School of Medicine, I-Shou University
| | - Ting-I Lin
- Department of Pediatrics, E-DA Hospital
- School of Medicine, I-Shou University
| | - Po-Jui Ko
- School of Medicine, I-Shou University
- E-DA Hospital Surgery Department, Pediatric Surgery Division
| | - Shu-Leei Tey
- Department of Pediatrics, E-DA Hospital
- School of Medicine, I-Shou University
| | - Ming-Lun Yeh
- School of Medicine, I-Shou University
- E-DA Hospital Surgery Department, Pediatric Surgery Division
| | - Hsuan-Yin Wu
- School of Medicine, I-Shou University
- E-DA Hospital Surgery Department, Cardiovascular Surgery Division, Kaohsiung
| | - Chien-Yi Wu
- Department of Pediatrics, E-DA Hospital
- School of Medicine, I-Shou University
| | - Yu-Chen S.H. Yang
- Joint Biobank, Office of Human Research, Taipei Medical University, Taipei, Taiwan
| | - San-Nan Yang
- Department of Pediatrics, E-DA Hospital
- School of Medicine, I-Shou University
| | - Yung-Ning Yang
- Department of Pediatrics, E-DA Hospital
- School of Medicine, I-Shou University
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University
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Al-Jazaeri A. Repair of congenital diaphragmatic hernia under high-frequency oscillatory ventilation in high-risk patients: an opportunity for earlier repair while minimizing lung injury. Ann Saudi Med 2014; 34:499-502. [PMID: 25971823 PMCID: PMC6074582 DOI: 10.5144/0256-4947.2014.499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Repair of congenital diaphragmatic hernia (CDH) is ideally delayed until ventilatory parameters are stabilized and patients are switched to conventional ventilation. However, in selected high-risk patients, repair can be performed earlier while they are still on high-frequency oscillatory ventilation (HFOV). DESIGN AND SETTINGS A retrospective review of all CDH cases treated in our tertiary referral center between 1997 and 2013. METHODS In 1997, we started repairing selected high-risk CDH cases under HFOV with or without inhaled nitric oxide (iNO). All repairs were performed once the infants' blood gas levels were acceptable. The infants were gradually weaned to conventional ventilation followed by extubation as their ventilatory parameters improved. Their records were reviewed to determine the group-wide outcomes. RESULTS Between 1997 and 2013, 55 infants with CDH were treated in our institute; of these 12 high-risk cases were repaired under HFOV/iNO combinations and 1 was repaired without iNO. All patients had significant pulmonary hypertension and 8 had herniated livers. The mean age at repair was 9.1 (6.3) days. Two mortalities occurred at the first and tenth postoperative days. Among the remaining 11 survivors, the median ventilation and hospitalization days were 29.5 (11-84) and 45.5 (25-107), respectively, and the median duration under HFOV and conventional ventilation days were 15 (9-40) and 12 (3-47), respectively. CONCLUSION CDH repair can be performed earlier under HFOV and iNO. The possible advantages are earlier restoration of normal anatomy and earlier start of enteral feeding while minimizing the risk of lung injury.
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Affiliation(s)
- Ayman Al-Jazaeri
- Ayman Al-Jazaeri, MD, Department of Surgery,, King Saud University,, PO Box 68578,, Riyadh 11537, Saudi Arabia, T: +966565994455,
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Bedside neonatal intensive care unit surgery- myth or reality! J Neonatal Surg 2013; 2:20. [PMID: 26023440 PMCID: PMC4420370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/24/2013] [Indexed: 12/02/2022] Open
Abstract
Neonatal transport is associated with complications, more so in sick and unstable neonates who need immediate emergency surgery. To circumvent these problems, surgery in Neonatal intensive care unit (NICU) is proposed for these neonates. This article reviews the literature regarding feasibility of this novel concept and based on the generated evidence, suggest the NICU planners to always include infrastructure for this. Also neonatal surgical team can be developed that could be transported.
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Where Should the Surgical Neonates be Nursed? J Neonatal Surg 2012; 1:24. [PMID: 26023383 PMCID: PMC4420384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/19/2012] [Indexed: 10/27/2022] Open
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Sarin YK, Bhatnagar S. On the birth of journal of neonatal surgery. J Neonatal Surg 2012; 1:2. [PMID: 26023361 PMCID: PMC4420315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 12/24/2011] [Indexed: 11/25/2022] Open
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Shooman D, Portess H, Sparrow O. A review of the current treatment methods for posthaemorrhagic hydrocephalus of infants. Cerebrospinal Fluid Res 2009; 6:1. [PMID: 19183463 PMCID: PMC2642759 DOI: 10.1186/1743-8454-6-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Accepted: 01/30/2009] [Indexed: 11/10/2022] Open
Abstract
Posthaemorrhagic hydrocephalus (PHH) is a major problem for premature infants, generally requiring lifelong care. It results from small blood clots inducing scarring within CSF channels impeding CSF circulation. Transforming growth factor – beta is released into CSF and cytokines stimulate deposition of extracellular matrix proteins which potentially obstruct CSF pathways. Prolonged raised pressures and free radical damage incur poor neurodevelopmental outcomes. The most common treatment involves permanent ventricular shunting with all its risks and consequences. This is a review of the current evidence for the treatment and prevention of PHH and shunt dependency. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) and PubMed (from 1966 to August 2008) were searched. Trials using random or quasi-random patient allocation for any intervention were considered in infants less than 12 months old with PHH. Thirteen trials were identified although speculative interventions were also evaluated. The literature confirms that lumbar punctures, diuretic drugs and intraventricular fibrinolytic therapy can have significant adverse effects and fail to prevent shunt dependence, death or disability. There is no evidence that postnatal phenobarbital administration prevents intraventricular haemorrhage (IVH). Subcutaneous reservoirs and external drains have not been tested in randomized controlled trials, but can be useful as a temporising measure. Drainage, irrigation and fibrinolytic therapy as a way of removing blood to inhibit progressive deposition of matrix proteins, permanent hydrocephalus and shunt dependency, are invasive and experimental. Studies of ventriculo-subgaleal shunts show potential as a temporary method of CSF diversion, but have high infection rates. At present no clinical intervention has been shown to reduce shunt surgery in these infants. A ventricular shunt is not advisable in the early phase after PHH. Evidence exists that pre-delivery corticosteroid therapy reduces mortality and IVH and there may be trends towards reduced disability in the short term. There is also evidence that postnatal indomethacin reduces IVH but with no effect on mortality or disability. Overall, there is still no definitive algorithm for the treatment of PHH or prevention of shunt dependence. New therapeutic approaches in neonatal care, including those aimed at pre-empting PHH, offer the best hope of improving neurodevelopmental outcomes.
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Affiliation(s)
- David Shooman
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, UK.
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