Overnight observation in former premature infants undergoing inguinal hernia repair

Laituri, Carrie A.; Garey, Carissa L.; Pieters, Benjamin J.; Mestad, P. H.; Weissend, Eric E.; Peter, Shawn D. St.

doi:10.1016/j.jpedsurg.2011.10.045

Cited by 13 publications

(9 citation statements)

References 15 publications

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“…A recent meta‐analysis suggested that former preterm infants with PCA < 46 weeks should be observed for at least 12 h, and that patient care should be individualized based on associated comorbidities for those between 46 and 60 weeks . A more recent report concluded that overnight observation after IH repair is recommended for infants born before 37 weeks gestation and aged <50 weeks PCA at surgery …”

Section: Discussionmentioning

confidence: 99%

Inguinal hernia in very low‐birthweight infants: Follow up to adolescence

Kurobe

Baba

Otsuka

2016

Pediatrics International

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The high incidence of IH in VLBWI was confirmed during follow up to adolescence. The rate of incarceration was low and the incidence of spontaneous regression was high. Observation up to 6 months without surgery, with the expectation of spontaneous regression, is one option to avoid unnecessary surgery, but repair should be performed before 10 months to reduce the risk of incarceration. Further large, prospective, and randomized controlled studies with a long follow up are necessary to validate the present results and to define the ideal time for IH repair in VLBWI.

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Section: Discussionmentioning

confidence: 99%

Inguinal hernia in very low‐birthweight infants: Follow up to adolescence

Kurobe

Baba

Otsuka

2016

Pediatrics International

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“…A recent meta-analysis recommended that former premature infants undergoing general anesthesia with PCA <46 weeks should be observed for at least 12 h postoperatively, but individualized patient care should be based on associated comorbidities for those between 46 and 60 weeks PCA. [ 11 ] Laituri et al .,[ 12 ] had reported overnight observation after HR for premature infants <50 weeks PCA. A high percentage of these premature infants had a postoperative event related to apnea in the recovery room, but not overnight.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the evolution of anesthetic practice, and the use of newer less soluble volatile anesthetic agents, infants have faster awakening in the recovery room. [ 12 ] Therefore, the incidence of apnea may have changed over the past decade as new agents are being used for general anesthesia. Murphy et al .,[ 13 ] believe that the risk of apnea is much lower in the current anesthetic practice.…”

Section: Discussionmentioning

confidence: 99%

Management of inguinal hernia in premature infants: 10-year experience

Crankson

Tawil

Namshan

et al. 2015

J Indian Assoc Pediatr Surg

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Aim:Debatable issues in the management of inguinal hernia in premature infants remain unresolved. This study reviews our experience in the management of inguinal hernia in premature infants.Materials and Methods:Retrospective chart review of premature infants with inguinal hernia from 1999 to 2009. Infants were grouped into 2: Group 1 had repair (HR) just before discharge from the neonatal intensive care unit (NICU) and Group 2 after discharge.Results:Eighty four premature infants were identified. None of 23 infants in Group 1 developed incarcerated hernia while waiting for repair. Of the 61 infants in Group 2, 47 (77%) underwent day surgery repair and 14 were admitted for repair. At repair mean postconceptional age (PCA) in Group1 was 39.5 ± 3.05 weeks. Mean PCA in Group 2 was 66.5 ± 42.73 weeks for day surgery infants and 47.03 ± 8.87 weeks for admitted infants. None of the 84 infants had an episode of postoperative apnea. Five (5.9%) infants presented subsequently with metachronous contralateral hernia and the same number of infants had hernia recurrence.Conclusions:Delaying HR in premature infants until ready for discharge from the NICU allows for repair closer to term without increasing the risk of incarceration. Because of low occurrence of metachronous hernia contralateral inguinal exploration is not justified. Day surgery HR can be performed in former premature infant if PCA is >47 weeks without increasing postoperative complications.

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“…The authors recommend administration of intravenous caffeine (10 mg/kg) to reduce the risk of apnea [16]. A more recent study suggests overnight observation for patients born before 37 weeks gestation who are under 50 weeks PCA [17]. However, a lack of consensus on the definitions of apnea and bradycardia creates a concerning source of bias in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Postoperative apnea after inguinal hernia repair in formerly premature infants: impacts of gestational age, postconceptional age and comorbidities

Özdemir

Arikan

2013

Pediatr Surg Int

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PurposeIt is common practice for premature infants undergoing elective inguinal hernia (IH) repair to be hospitalized for postoperative apnea monitoring. This study evaluated the risk of apnea after IH repair with regard to gestational age (GA) and postconceptional age (PCA) in formerly premature infants.MethodsFormerly premature infants who had undergone elective IH repair between 01/2000 and 12/2012 were reviewed retrospectively in terms of GA, PCA, body weight, and comorbidities. All postoperative apneas were evaluated.ResultsA total of 428 formerly premature infant charts were reviewed. Eleven babies had postoperative apnea. Infants younger than 45 weeks PCA were found more prone to develop postoperative apnea after IH repair. In older infants (PCA between 46 and 60 weeks), comorbidities create predisposition to apnea postoperatively. These comorbidities are bronchopulmonary dysplasia, necrotizing enterocolitis and former apnea episodes. Anemia and lower birth weight are also risk factors.ConclusionThis study suggests that low GA and PCA, low birth weight, anemia, and complicated past medical history affect respiratory complication rates, particularly apnea in formerly premature infants undergoing elective IH repair. Severe apneas occurred earlier than mild ones. Overnight monitoring is mandatory in small infants with low GA and PCA. Otherwise healthy, older infants may be operated on outpatient basis.

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Overnight observation in former premature infants undergoing inguinal hernia repair

Cited by 13 publications

References 15 publications

Inguinal hernia in very low‐birthweight infants: Follow up to adolescence

Inguinal hernia in very low‐birthweight infants: Follow up to adolescence

Management of inguinal hernia in premature infants: 10-year experience

Postoperative apnea after inguinal hernia repair in formerly premature infants: impacts of gestational age, postconceptional age and comorbidities

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