Current management of surgical neonates: is it optimal or do we need to improve? A national survey of the Italian Society of Neonatology
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In brief
In brief
This Italian national survey reveals gaps in perioperative management of surgical neonates, including limited neonatologist involvement during surgery, underutilization of bedside procedures for unstable infants, and lack of standardized care protocols. The study identifies key barriers and opportunities to optimize surgical care for this vulnerable population.
- Neonatologists are involved in intraoperative management in only 43% of Italian NICUs, indicating suboptimal multidisciplinary collaboration.
- Bedside surgery is underutilized, primarily reserved for extremely preterm or unstable infants, with surgeon preference for OR being main barrier.
- Only 43% of centers have care protocols for specific surgical conditions, revealing significant gaps in standardized perioperative management.
- Surgical-anesthesiology team preference for standard OR (77.5%) limits bedside surgery adoption despite benefits for high-risk neonates.
- Survey identifies three priority areas for improvement: neonatologist involvement, bedside surgery expansion, and protocol development.
Written by the GCMD Library team from the article.
Abstract
Purpose
Few guidelines exist for the perioperative management (PM) of neonates with surgical conditions (SC). This study examined the current neonatal PM in Italy.
Methods
We invited 51 neonatal intensive care units with pediatric surgery in their institution to participate in a web-based survey. The themes included (1) the involvement of the neonatologist during the PM; (2) the spread of bedside surgery (BS); (3) the critical issues concerning the neonatal PM in operating rooms (OR) and the actions aimed at improving the PM.
Results
Response rate was 82.4%. The neonatologist is involved during the intraoperative management in 42.9% of the responding centers (RC) and only when the surgery is performed at the patient’s bedside in 50.0% of RCs. BS is reserved for extremely preterm (62.5%) or clinically unstable (57.5%) infants, and the main barrier to its implementation is the surgical-anesthesiology team's preference to perform surgery in a standard OR (77.5%). Care protocols for specific SC are available only in 42.9% of RCs.
Conclusion
Some critical issues emerged from this survey: the neonatologist involvement in PM, the spread of BS, and the availability of specific care protocols need to be implemented to optimize the care of this fragile category of patients.