Laparotomy for necrotizing enterocolitis: intensive care nursery compared with operating theatre.

Objective: To determine whether neonates requiring laparotomy for necrotizing enterocolitis (NEC) are more stable perioperatively and have less disruption of physiological parameters if surgery is performed in the neonatal intensive care unit (NICU) compared with the operating theatre (OR).

Methodology: A retrospective case review was performed on 233 neonates referred for further surgical management of severe NEC in the period January 1989 to December 1997. Mortality and morbidity were compared by calculating the score for neonatal acute physiology (SNAP) and its attendant risk of mortality score. Thirty-six separate physiological variables were also compared pre- and postoperatively and the mean postoperative change was calculated.

Results: For neonates weighing less than 1500 g, mortality was linked to illness severity, as measured by SNAP, rather than operative location. Specific adverse events associated with secondary transfer to the OR included hypothermia, deterioration in oxygenation parameters, ventilation parameters and platelet count. The liberal use of blood products, albumin and bicarbonate 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 such use should be encouraged. In contrast, secondary transport of neonates weighing less than 1500 g to the OR for laparotomy is associated with significant deterioration in a number of physiological parameters, which may impact on morbidity.