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Analytical data review of neonatal perioperative care in a UK neonatal intensive care unit

Presented at the Neonatal Society 2016 Spring Meeting.

Rajendran G1, Lakhoo K2, Choi A3, O’Brien F1

1 Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, OX3 9DU, United Kingdom.
2 Department of Paediatric sugery, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom.
3 Department of Anesthesiology, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom.

Background: The goal of neonatal perioperative care is to maintain homeostasis during the perioperative period. In order to achieve this, multi-disciplinary teams have to formulate management guidelines by extrapolating the data from studies involving older children and adults as there is paucity of data in neonates. We collected data relevant to perioperative care in a neonatal intensive care unit (NICU), with a focus on identifying key areas of clinical care around the time of surgery.

Methods: Perioperative data of neonates who underwent surgical intervention in 2013 within a UK NICU were collected retrospectively. Temperature, blood sugar levels, serum sodium levels, blood gas parameters, weight and fluids used (type and volume) in the perioperative period along with demographic details and indication for surgery were collected from individual case notes. The data was analysed for the distribution and trend of temperature, blood sugar and parameters pertaining to fluid, electrolyte and acid-base balance in the perioperative period.

Results: Forty-eight neonatal surgical procedures in forty-five neonates were studied. Median gestational age (IQR) at the time of surgery and weight before surgery were 37 (33 to 39) weeks and 2750 (1872 to 2942) grams. The number of surgical procedures for NEC, abdominal wall defects and other reasons were 14, 11 and 23 respectively. There was no postoperative hypothermia (Median (IQR) temperature 36.9 (36.5 to 37) ºC). Hypoglycaemia was observed both pre-operatively (10% of babies) and postoperatively (6%). Hyperglycaemia was more common post-operatively (63% vs 13%). There was no hypocapnia pre-operatively but post-operatively 19% of neonates had pCO2 ≤ 4kPa. Hyponatraemia (42%) and hypernatraemia (4%) remained same. Blood sugar levels showed a rapid increase in the post-operative period followed by a gradual decrease in all groups except in preterm and NEC neonates where there was a slow and sustained increase in blood sugar level. Statistically significant weight gain occurred in preterm and NEC neonates.

Conclusion: Preterm neonates and neonates with NEC were identified as the highest risk groups. Thermal care was good. Although hyponatraemia was common pre-operatively, appropriate free-water intake during surgery avoided increased rates of hyponatraemia post-operatively. We have identified that hyperglycaemia in the post-operative period needs to be addressed. This will include a review of the administration of glucose as an infusion during the intra-operative period.

Corresponding author: gauthamen.rajendran@ouh.nhs.uk

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