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Emergency Laparotomy in the Neonatal Intensive Care Unit: A Systematic Review of Indications and Outcomes

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Topic overview

This systematic review examines emergency laparotomy performed at the bedside in neonatal intensive care units versus traditional operating theatre procedures. Despite treating higher-risk premature infants, cotside surgery shows comparable mortality and morbidity rates while avoiding transfer-related complications like tube dislodgement and hypothermia.

Key takeaways

  • Cotside laparotomy in NICU is safe and feasible with comparable mortality (24%) and morbidity (8%) to theatre-based surgery.
  • Neonates undergoing cotside surgery are higher-risk: lower birthweight (~1,305g vs 2,941g) and gestational age (~29.5 vs 34.3 weeks).
  • Transfer to theatre poses significant risks including endotracheal tube dislodgement and hypothermia in critically ill neonates.
  • Only 33% of institutions have formal guidelines for cotside surgery despite its widespread use across 20 surgical sites globally.
  • Surgical location decisions should be multidisciplinary, considering cardiorespiratory status and institutional capabilities.

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How to cite: GlobalCastMD. Emergency Laparotomy in the Neonatal Intensive Care Unit: A Systematic Review of Indications and Outcomes. GlobalCastMD Medical Library. 2025-12-19. https://library.globalcastmd.com/article/11328

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