Enhanced Recovery After Surgery (ERAS) Society Recommendations for Neonatal Perioperative Care

Part of Neonatal Surgery Essentials 7 items

Infographic · Oct 2024 · 1 min read

In brief

This ERAS Society guideline provides 16 evidence-based recommendations for perioperative care of surgical neonates in NICUs, covering team communication, fasting, temperature management, antibiotics, ventilation, fluid/glucose control, and parental involvement. Developed through modified Delphi consensus by multidisciplinary experts, these unit-wide protocols apply across varied neonatal surgical pathology to standardize care and improve outcomes.

ERAS guidelines now exist specifically for neonates in NICUs undergoing major noncardiac surgery during first 28 days of life.
16 evidence-based recommendations cover team communication, fasting, temperature, antibiotics, ventilation, fluids, glucose, and feeding.
Unit-wide ERAS protocols can be applied across varied neonatal surgical pathology to standardize perioperative care.
Insufficient evidence exists for recommendations on nasogastric tubes, Foley catheters, and central line management in neonates.
Multidisciplinary consensus (surgeons, anesthesiologists, neonatologists, nurses) drives neonatal ERAS implementation in NICUs.

Written by the GCMD Library team from the infographic.

The infographic uses a three-column layout with a dark red sidebar on the left containing methodology icons and text. The center column shows an illustration of a neonate with medical instruments. The right two columns present recommendations in light gray boxes with orange icons illustrating each recommendation (antiseptic bottle, breast milk bottle, hands, thermometer, and team communication symbols).

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

The text in the image

Read it at the source ↗