Authors (including presenting author) :
Chee YY(1), Hung GK(1), Lee W(1), Tam YH(2), Yuen V(3), Wong RMS(1)
Affiliation :
(1)Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital (2)Department of Paediatric Surgery, Hong Kong Children's Hospital
(3)Department of Anaesthesiology and Perioperative Medicine, Hong Kong Children's Hospital
Introduction :
Neonatal Intensive Care Unit (NICU) at the Hong Kong Children’s Hospital (HKCH) is a tertiary referral centre for neonatal surgical cases. An operating theatre (OT) is built inside the HKCH NICU to facilitate surgeries for high risk neonates (babies that are too sick to be transferred out of the NICU to the main OT for operation) or neonates requiring short-duration operation/procedure to minimize the transport time to main OT. Training and drills are carried out together with the NICU, surgical and anaesthetic teams before service commencements in April 2024.
Objectives :
To ensure the usage of the NICU OT is matching the planned service scope.
Methodology :
To review the utility of the NICU OT at the HKCH during the period from April to December 2024, using the OT booking system at the Clinical Management System.
Result & Outcome :
A total of 16 operations/procedures were performed during the 9-month period (April to December 2024). The mean corrected gestational age at the time of operation/procedure is 34 weeks (range 24-48 weeks), mean body weight 2.1kg (range 0.62-4.68kg). The most common operation being performed at the NICU OT (under general anaesthesia) is laparotomy (n=8) for gut resection and stoma creation or stoma closure. There is one cardiac surgery with ligation of the patent ductus arteriosus. The most common procedure being done inside the NICU OT (without the need for general anaesthesia) is intraocular lucentis injection for retinopathy of prematurity (n=4), followed by muscle biopsy (n=1), insertion of haemodialysis catheter (n=1) and insertion of pigtail as abdominal drainage (n=1). Around 40% of the patients (6 out of 16) were critically ill requiring the use of high frequency ventilation and/or inotropic support. All patients were clinically stable during the operation/procedure. One patient became unstable after the operation when transferring back to the NICU due to a downhill clinical course, all other patients remained stable when transferred back to the NICU after the operation/procedure.
The usage of HKCH NICU OT is reserved to those high risk neonates that are too ill or unstable to be transported to the main OT for operation. From the review, these are usually the preterm babies with extremely low birth weight with necrotizing enterocolitis or spontaneous intestinal perforation. With the establishment of the NICU OT, these high risk neonates could undergo emergency operation inside the NICU (minimizing the transport time). These neonates could also be supported by NICU medical/nursing team (together with the anaesthetic team) in a timely manner if necessary due to its close proximity to the NICU. Moreover, these critically ill neonates could be directly transferred to the HKCH NICU OT from the regional hospital to perform the operation, minimizing the need of bed transferal repeatedly. In summary, critically ill neonates and neonates requiring short-duration operation/procedure benefited from the establishment of OT inside the HKCH NICU.
