Bedside laparotomy in the extremely low birth weight baby: a plea to bring the surgeon to the baby.
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.


OBJECTIVE
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.
Arbell
Dan
D
Department of Pediatric Surgery, Hadassah-Hebrew Medical Center, Ierusalem, Israel. arbell@hadassah.org.il
Gross
Eitan
E
Preminger
Avia
A
Naveh
Yaron
Y
Udassin
Raphael
R
Gur
Ilan
I
D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000401:mortality / Q000601:surgery*; D007557:Israel / Q000453:epidemiology; D007813:Laparotomy / Q000379:methods*; D008297:Male; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D015996:Survival Rate