Scope and feasibility of operating on the neonatal intensive care unit: 312 cases in 10 years.
OBJECTIVE
To report the scope, feasibility and learning experience of operating on neonates on the neonatal intensive care unit (NICU).


METHODS
(1) Review of all NICU operations performed by general neonatal surgeons over 10 years; (2) 6-month prospective comparison of procedures performed in NICU or operating room; (3) structured interviews with five surgeons with 1-13 years experience of operating on NICU.


RESULTS
312 operations were performed in 249 infants. Median birth weight was 1,494 g (range 415-4,365), gestational age 29 weeks (22-42), and age at operation 25 days (0-163). Nearly half (147) were laparotomy for acute abdominal pathology in preterm, very low birth-weight infants There were no surgical adverse events related to location of surgery. Surgeon satisfaction with operating on NICU for this population was high (5/5). Several factors contribute to making this process a success.


CONCLUSIONS
This is the largest reported series of general neonatal surgical procedures performed on NICU. Operating on NICU is feasible and safe, and a full range of neonatal operations can be performed. It removes risks associated with neonatal transfer and is likely to reduce physiological instability. We recommend this approach for all ventilated neonates and urge neonatal surgeons to operate at the cotside of unstable infants.
Wessex Regional Centre for Neonatal Surgery, Department of Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD, UK. n.hall@suht.swest.nhs.uk
N J
NJ
Hall
M P
MP
Stanton
L J
LJ
Kitteringham
R A
RA
Wheeler
D M
DM
Griffiths
M
M
Drewett
D M
DM
Burge
D001724:Birth Weight; D016638:Critical Illness; D004065:Digestive System Abnormalities / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006113:United Kingdom