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Pediatric Surgery International

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01-06-2019 | Ileostomy | Original Article

Enhanced recovery after surgery (ERAS) protocols in neonates should focus on the respiratory tract

Authors: Yuji Wakimoto, Sathyaprasad Burjonrappa

Published in: Pediatric Surgery International | Issue 6/2019

Abstract

Background/purpose

Enhanced recovery after surgery (ERAS) protocols have shown significant benefits in terms of patient outcomes and institutional cost savings in colorectal and bariatric surgery. This has not, however, been tried in the neonatal setting. One of the major barriers to developing ERAS protocols in the neonatal intensive care unit (NICU) is the often-prolonged intubation of neonates after surgery. To this end, we evaluated our institutional data to determine if prolonged intubation post-operatively is associated with adverse events.

Methods

This is a retrospective cohort study of neonates who were intubated for a surgical procedure from January 2012 to December 2016. Documented data included pre-operative intubation status, timing of post-operative extubation: immediate (< 24 h) or delayed (> 24 h), and adverse respiratory events. The Fisher exact test and Student’s t test were used to study differences amongst categorical and continuous variables, respectively.

Results

58 surgical procedures were identified, where the patient was intubated specifically for the surgical intervention, of which 28 were extubated immediately and 30 were extubated in a delayed fashion. The overall incidence of adverse respiratory events was increased in the delayed extubation group (P = 0.03).

Conclusions

Healthcare providers should encourage early extubation after neonatal surgery. Consideration should be given to implementing ERAS protocols in NICUs.

Level of evidence

Prognosis study—level II.

Harris KC, Holowachuk S, Pitfield S, Sanatani S, Froese N, Potts JE et al (2014) Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg 148:2642–2648. https://doi.org/10.1016/j.jtcvs.2014.06.093 CrossRefPubMed

Lawrence EJ, Nguyen K, Morris SA, Hollinger I, Graham DA, Jenkins KJ et al (2013) Economic and safety implications of introducing fast tracking in congenital heart surgery. Circ Cardiovasc Qual Outcomes 6:201–207CrossRefPubMed

Howard F, Brown KL, Garside V, Walker I, Elliott MJ (2010) Fast-track pediatric cardiac surgery: the feasibility and benefits of a protocol for uncomplicated cases. Eur J Cardiothorac Surg 37:193–196CrossRefPubMed

Gurria J, Kuo P, Kao A, Christensen L, Holterman A (2018) General endotracheal vs. non-endotracheal regional anesthesia for elective inguinal hernia surgery in very preterm neonates: a single institution experience. J Pediatr Surg 52:56–59. https://doi.org/10.1016/j.jpedsurg.2016.10.019 CrossRef

Varghese J, Kutty S, Abdullah I, Hall S, Shostrom V, Hammel JM (2016) Preoperative and intraoperative predictive factors of immediate extubation after neonatal cardiac surgery. Ann Thorac Surg 102:1588–1595. https://doi.org/10.1016/j.athoracsur.2016.04.030 CrossRefPubMed

Wielenga JM, Van den Hoogen A, Van Zanten HA, Helder O, Bol B, Blackwood B (2016) Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in newborn infants. Cochrane Database Syst Rev 3:CD011106. https://doi.org/10.1002/14651858.CD011106.pub2 CrossRefPubMed

Walsh MC, Morris BH, Wrage LA, Vohr BR, Poole WK, Tyson JE et al (2005) Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr 146:798–804. https://doi.org/10.1016/j.jpeds.2005.01.047 CrossRefPubMed

Miller JD, Carlo WA (2008) Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol 35:273–281. https://doi.org/10.1016/j.clp.2007.11.004 CrossRefPubMed

Robbins M, Trittmann J, Martin E, Reber KM, Nelin L, Shepherd E (2015) Early extubation attempts reduce length of stay in extremely preterm infants even if re-intubation is necessary. J Neonatal Perinatal Med 8:91–97. https://doi.org/10.3233/NPM-15814061 CrossRefPubMed

10.

Biniwale M, Wertheimer F (2017) Decrease in delivery room intubation rates after use of nasal intermittent positive pressure ventilation in the delivery room for resuscitation of very low birth weight infants. Resuscitation 116:33–38. https://doi.org/10.1016/j.resuscitation.2017.05.004 CrossRefPubMed

11.

Al-Mandari H, Shalish W, Dempsey E, Keszler M, Davis PG, Sant’anna G (2015) International survey on periextubation practices in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 100:F428–F431. https://doi.org/10.1136/archdischild-2015-308549 CrossRefPubMed

12.

Lago P, Boccuzzo G, Garetti E, Pirelli A, Pieragostini L, Merazzi D et al (2013) Pain management during invasive procedures at Italian NICUs: has anything changed in the last five years? J Matern Neonatal Med 26:303–305. https://doi.org/10.3109/14767058.2012.733783 CrossRef

13.

Menon G, McIntosh N (2008) How should we manage pain in ventilated neonates? Neonatology 93:316–323CrossRefPubMed

14.

Anand KJS, Hall RW (2007) Controversies in neonatal pain: an introduction. Semin Perinatol 31:273–274. https://doi.org/10.1053/j.semperi.2007.07.014 CrossRefPubMed

15.

Prestes ACY, Balda RDCX, Dos Santos GMS, Rugolo LMSDS, Bentlin MR, Magalhães M et al (2016) Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten-year period? J Pediatr (Rio J) 92:88–95. https://doi.org/10.1016/j.jped.2015.04.009 CrossRef

16.

Hall RW (2013) Anesthesia and analgesia in the NICU. NIH Public Access 39:239–254. https://doi.org/10.1016/j.clp.2011.12.013.Anesthesia CrossRef

17.

Fontánez-Nieves TD, Frost M, Anday E, Davis D, Cooperberg D, Carey AJ (2016) Prevention of unplanned extubation in neonates through process standardization. J Perinatol 36:469CrossRefPubMed

Title: Enhanced recovery after surgery (ERAS) protocols in neonates should focus on the respiratory tract
Authors: Yuji Wakimoto
Sathyaprasad Burjonrappa
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Ileostomy
Pediatric Cardiac Surgery
Published in: Pediatric Surgery International / Issue 6/2019
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-019-04437-w

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Springer Medicine

Enhanced recovery after surgery (ERAS) protocols in neonates should focus on the respiratory tract

Abstract

Background/purpose

Methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background/purpose

Methods

Results

Conclusions

Level of evidence

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