Outcomes of laparotomy in preterm infants with extremely low operative weight (< 1000 g).

Purpose: Most studies on outcomes of surgery in extremely premature neonates include cases based on birth weight irrespective of weight at the time of surgery. Reported figures may not accurately reflect what is truly experienced in babies with smaller weight at the time of surgery. This study sought to document the outcomes of laparotomy in preterms at extremely low operative (ELOW) of < 1000 g.

Methods: Preterm infants weighing < 1000 g at the time of laparotomy were identified from a prospectively collected database. Data were collected over 12 years (Sept 2007-Mar 2020). Primary outcome investigated was in-hospital mortality. Other outcomes including long-term morbidities are reported.

Results: 79 ELOW infants were included. Median gestational age was 25 weeks (23-29 weeks) and median birth weight 680 g (382-986 g). The median weight at laparotomy was 755 g (380-993 g) at a median age of 11 days of life (1-38 days). The commonest diagnoses at laparotomy included: necrotising enterocolitis 44 (56%), spontaneous intestinal perforation 20 (25%) and meconium obstruction of prematurity 5 (6%). The median predicted mortality using CRIB II scoring system was 35%. 21 (27%) in-hospital mortality was recorded. Babies who died had significantly lower operative weight (610 vs 767 g p = 0.0303) compared to those who survived despite no significant difference in birth weight. 30% had one or more surgical complications. 50% had no recorded morbidity at 2-year assessment while 19% had severe impairment.

Conclusion: 73% of preterm infants that underwent laparotomy at < 1000 g survived to discharge and 50% of survivors had no long-term morbidity. Association between mortality and lower operative weight at laparotomy is shown. This study provides a focused data on the ELOW category of patients which could more accurately guide counselling and management decisions.