Enhanced Recovery After Surgery (ERAS) Society Recommendations for Neonatal Perioperative Care
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Mercedes Pilkington, Gregg Nelson, Brandon Pentz, Tyara Marchand, Erin Lloyd, Priscilla P. L. Chiu, David de Beer, Nicole de Silva, Scott Else, Annie Fecteau, Stefano Giuliani, Simon Hannam, Alexandra Howlett, Kyong-Soon Lee, David Levin, Lorna O’Rourke, Lori Stephen, Lauren Wilson, Mary E. Brindle
Importance: Neonates requiring surgery are often cared for in neonatal intensive care units (NICUs). Despite a breadth of surgical pathology, neonates share many perioperative priorities that allow for the development of unit-wide evidence-based Enhanced Recovery After Surgery (ERAS) recommendations.
Observations: The guideline development committee included pediatric surgeons, anesthesiologists, neonatal nurses, and neonatologists in addition to ERAS content and methodology experts. The patient population was defined as neonates (first 28 days of life) undergoing a major noncardiac surgical intervention while admitted to a NICU. After the first round of a modified Delphi technique, 42 topics for potential inclusion were developed. There was consensus to develop a search strategy and working group for 21 topic areas. A total of 5763 abstracts were screened, of which 98 full-text articles, ranging from low to high quality, were included. A total of 16 recommendations in 11 topic areas were developed with a separate working group commissioned for analgesia-related recommendations. Topics included team communication, preoperative fasting, temperature regulation, antibiotic prophylaxis, surgical site skin preparation, perioperative ventilation, fluid management, perioperative glucose control, transfusion thresholds, enteral feeds, and parental care encouragement. Although clinically relevant, there were insufficient data to develop recommendations concerning the use of nasogastric tubes, Foley catheters, and central lines.
Conclusions and Relevance: Despite varied pathology, neonatal perioperative care within NICUs allows for unit-based ERAS recommendations independent of the planned surgical procedure. The 16 recommendations within this ERAS guideline are intended to be implemented within NICUs to benefit all surgical neonates.
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What are the best evidence-based guidelines for newborns who need non-cardiac surgery in the NICU? I'm Lizzie Lee from Cincinnati Children's Hospital, and this is an article you should know about. The ERRAS, or the Enhanced Recovery After Surgery Society, used a modified Delphi technique, which is a fancy way of saying that a multidisciplinary group of experts gathered together to reach more than a 70% consensus. Their goal was to develop recommendations that NICUs can use to take care of the newborns during and after surgery. Focusing on the needs that they have when they are undergoing different types of surgeries. So what did they come up with? They agreed on 16 recommendations covering 11 topics like team communication, pre-surgery fasting, temperature control, and antibiotic use. However, they did not have enough data to make recommendations about things like nasogastric tubes and central lines. These new guidelines will help improve care for NICU patients undergoing surgery. Let us know what you think in the comments below and stay tuned for more articles that you should know about.