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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. 2020 Dec 5:S0022-3468(20)30887-3. doi: 10.1016/j.jpedsurg.2020.11.029. Epub ahead of print. PMID: 33334555.

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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