Introduction
Methods
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First step: preparation of a complete list of the Italian pediatric surgery centers with e-mail contacts. Pediatric surgery center was defined as a formally recognized structure in a public hospital, belonging either to the national health service or to a university, with beds and staff specifically dedicated to the care of pediatric surgical patients. Structures in private for-profit hospitals and pediatric surgical beds in general surgery and pediatrics departments were excluded.
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Second step: preparation of the survey questionnaire (Table 1), designed after thorough consultation among ISPS executive board members. The aim was to produce a tool that was simple and rapid to complete, but that would collect as many useful details as possible (general data, staff data and workload data of the centers). The questionnaire was distributed by means of an online cloud-based software instrument (Survey Monkey) to all pediatric centers.
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Third step: collection and processing of data obtained with the questionnaire.
Questions | Choices | Answer (Total n = 34) n (%) |
---|---|---|
The institution in which you work is provided with: | □ Neonatal Intensive Care Unit | 33 (97.06) |
□ Pediatric Surgery Unit | 34 (100) | |
□ Prenatal diagnosis and counseling Unit | 27 (79.41) | |
The institution where you work is located: | □ Northern | 15 (44.12) |
□ Southern and islands | 14 (41.18) | |
□ Central | 5 (14.71) | |
How many doctors work in your operative unit? | □ ≤3 | 1 (2.94) |
□ 4 | 3 (8.82) | |
□ 5 | 4 (11.76) | |
□ 6–10 | 19 (55.88) | |
□ > 10 | 7 (20.59) | |
How many doctors are dedicated to neonatal surgery in your unit? | □ 1 | 2 (2.88) |
□ 2 | 4 (11.78) | |
□ 3 | 6 (17.65) | |
□ 4 | 7 (20.59) | |
□ 5 | 6 (17.65) | |
□ > 5 | 9 (26.47) | |
How many nurses work in your unit? | □ 5 | 2 (5.88) |
□ 6–10 | 5 (14.71) | |
□ 11–15 | 13 (38.24) | |
□ 16–20 | 7 (20.59) | |
□ > 20 | 7 (20.59) | |
How many nurses are dedicated to neonatal surgery in your unit? | □ < 5 | 20 (62.50) |
□ 5–10 | 2 (6.32) | |
□ 11–15 | 7 (21.88) | |
□ > 15 | 3 (9.38) | |
How many beds are there in your pediatric surgery unit? | □ ≤10 | 9 (26.47) |
□ 11–15 | 10 (29.41) | |
□ 16–20 | 9 (26.47) | |
□ > 20 | 6 (17.65) | |
Practices on surgery | ||
How many beds are dedicated to neonatal surgery in NICU and/or in your surgical unit? | □ < 5 | 25 (75.76) |
□ 5–10 | 6 (18.18) | |
□ 11–15 | 1 (3.03) | |
□ > 15 | 1 (3.03) | |
How many neonatal surgical interventions in operative rooom or bedside are performed annually (last year) in your surgical unit? | □ < 20 | 7 (20.59) |
□ 21–30 | 15 (44.12) | |
□ 31–50 | 6 (17.65) | |
□ > 50 | 6 (17.65) | |
Is bedside surgery routine in selected unstable cases in your NICU? | □ Yes | 27 (79.42) |
□ No | 7 (20.59) | |
What do you think are the main problems that could contraindicate a surgical intervention in the NICU on selected patients? | □ Unavailability of rooms at the NICU | 23 (74.19) |
□ Lack of legal regulation | 11 (35.48) | |
□ Increased technical risk due to limited surgeon experience | 11 (35.48) | |
□ Increased infection risk | 9 (29.03) | |
□ Unavailability of the neonatological team to consider this approach | 9 (29.03) | |
□ Denial of Head of Health Management Unit | 2 (6.45) | |
□ Other | 5 (16.13) |
Statistical analysis
Results
General and staff data for surveyed pediatric surgery centers
Bedside surgery in the NICU: workload data
Questions | Choices | Answer (Total n = 27) n (%) |
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Practices on surgery | ||
2002How many newborns per year are treated with surgery in NICU? | □ < 5 | 12 (44.44) |
□ 5–10 | 11 (40.74) | |
□ > 10 | 4 (14.81) | |
Does the institute where you work receive babies from other centers for urgent surgical treatment? | □ Yes | 27 (100) |
Is the NICU, or part of the premises of which it is constituted, equipped with positive pressure? | □ Yes | 19 (70.37) |
□ No | 8 (29.62) | |
Bedside selection criteria | ||
Which patients are most likely to be considered for surgical interventions in NICU according to weight and gestational age? | □ Preterm neonates with birthweight < 1200 g | 24 (88.89) |
□ Preterm neonates with birthweight < 1500 g | 23 (85.18) | |
□ Term neonates | 17 (62.96) | |
What are the general criteria for selecting candidates for surgery in NICU? | □ Cardiorespiratory instability | 27 (100) |
□ Ventilatory dependance | 17 (62.96) | |
□ Weight | 17 (62.96) | |
□ Gestational age | 13 (48.14) | |
□ Other | 6 (22.22) | |
What are the procedures and pathologies that may be considered as indications to surgery in NICU? | □ Pneumothorax drenage | 25 (92.60) |
□ Pneumoperitoneum treatment | 24 (88.89) | |
□ Pleural effusion drenage | 23 (85.18) | |
□ Pericardial effusion drenage | 23 (85.18) | |
□ CVC positioning | 22 (81.48) | |
□ Patent ductus arteriosus ligation | 18 (66.67) | |
□ Congenital diaphragmatic hernia repair | 18 (66.67) | |
□ NEC treatment | 17 (62.96) | |
□ Dialysis catheter positioning | 14 (51.85) | |
□ Thoracic surgery | 2 (7.40) | |
□ Other | 2 (7.40) | |
Is bedside surgery performed via thoracic or laparoscopic approach in your unit? | □ No | 27 (100) |
Practices on perioperative monitoring | ||
What kind of anesthetic procedure is implemented at surgery in the NICU? | □ Endovenous | 25 (92.60) |
□ Inhaled | 16 (59.25) | |
□ Locoregional | 12 (44.45) | |
Who monitors the newborn during the surgical procedure? | □ Neonatologist | 5 (18.51) |
□ Anesthesiologist | 2 (7.40) | |
□ Both | 20 (74.07) | |
Who manages sedation and pain control procedures after surgery? | □ Multidisciplinary management | 21 (77.78) |
□ Neonatologist | 5 (18.51) | |
□ Pediatric surgeon | 4 (14.81) | |
□ Anesthesiologist | 2 (7.40) | |
Organizative procedures | ||
Is there a specific reference to surgery being conducted at the bedside in the informed consent? | □ Yes | 9 (33.33) |
□ No | 18 (66.67) | |
Is there an official pathway or institutional protocol for surgery in the NICU? | □ Yes | 8 (29.62) |
□ No | 19 (70.37) | |
Do you refer to specific literature sources to support the practice of NICU surgical procedures? | □ Yes | 15 (55.56) |
□ No | 12 (44.44) | |
Do you consider it important, for the purpose of quality of assistance in this fragile category, to reach a uniform vision on the appropriacy of proceeding with selected surgical procedures within the NICU? | □ Yes | 25 (92.60) |
□ No | 2 (7.40) |