WOFAPS 2025 8th World Congress of Pediatric Surgery

Simran Sehdev, Benjamin O'Sullivan, Benjamin Blaise, Geraint Lee, Andrew Selman, Iain Yardley

Evelina London Children's Hospital, London, United Kingdom

Introduction

Emergency neonatal laparotomy can be undertaken on the intensive care unit (ICU) or in the operating theatre. The evidence-base establishing indications, benefits or disadvantages is limited. We conducted a national survey of UK neonatal surgical centres to describe current practice.

Methods

A 15-item online survey was developed, and responses sought from one anaesthetist, neonatologist and paediatric surgeon at each of the 25 paediatric surgery centres in the UK. Quantitative responses were analysed with descriptive statistics (IBMSPSS V3.0). Free-text responses were subjected to qualitative thematic analysis.

Results

23 anaesthetists, 23 neonatologists, and 23 paediatric surgeons responded (69/75; 92%). At least one response was received from every centre. Cotside laparotomy is carried out in 22 (88%) of centres. 44 (64%) respondents preferred operating in theatre although a significant minority favoured cotside surgery (13 (19%)). Only 5 (20%) centres reported having formal indications for cotside laparotomy. Centres with established pathways performed a significantly higher proportion of cotside laparotomies compared to centres without established guidelines (p<0.001). Factors influencing decision to operate at the cotside were patient-specific: cardiovascular instability (86%), ventilator dependence (70%) and low birthweight (42%). 46 (67%) respondents recalled complications associated with theatre-based operating including hypothermia (41%), airway complications (15%) and cardiovascular instability (10%). Respondents perceived ICU-based surgery to be constrained by limited space (62%), disturbance to NICU families and staff (56%) and lack of neonatal surgical instruments (49%). Sites with geographical/ infrastructural constraints necessitating ambulance transfer raised concerns over delays and increased physiological risk. Several sites with co-located birth centres expressed similar concerns, and still decided to operate cotside, despite shorter transfer journey occurring within in the same building.

Discussion

This study establishes the first UK dataset on location of neonatal laparotomy, revealing marked variation in practice based on institutional preference and signalling need for national guideline development.