Laparotomy for necrotizing enterocolitis: Intensive care nursery compared with operating theatre

Objective: To determine whether neonates requiring laparotomy for necrotizi ng enterocolitis (NEC) are more stable perioperatively and have less disrup tion of physiological parameters if surgery is performed in the neonatal in tensive care unit (NICU) compared with the operating theatre (OR). Methodology: A retrospective case review was performed on 233 neonates refe rred for further surgical management of severe NEC in the period January 19 89 to December 1997. Mortality and morbidity were compared by calculating t he score for neonatal acute physiology (SNAP) and its attendant risk of mor tality score. Thirty-six separate physiological variables were also compare d pre- and postoperatively and the mean postoperative change was calculated . Results: For neonates weighing less than 1500 g, mortality was linked to il lness severity, as measured by SNAP, rather than operative location. Specif ic adverse events associated with secondary transfer to the OR included hyp othermia, deterioration in oxygenation parameters, ventilation parameters a nd platelet count. The liberal use of blood products, albumin and bicarbona te in perioperative resuscitation may have obscured other effects. Conclusions: The use of the neonatal intensive care nursery for surgery on neonates weighing less than 1500 g with severe NEC can be justified and suc h use should be encouraged. In contrast, secondary transport of neonates we ighing less than 1500 g to the OR for laparotomy is associated with signifi cant deterioration in a number of physiological parameters, which may impac t on morbidity.