Intensive Care and the Surgical Neonate

  • Francis A. Potter


This chapter examines the role of the Intensive Care Unit in the management of the surgical neonate. It discusses some of the techniques that are used and looks at the requirements of some specific neonatal conditions.


Intensive care and the Surgical Neonate Ventilation Newborn surgery 


  1. 1.
    Petroysan M, Estrada J, Hunter C, Woo R, Stein J, Ford HR, Anselmo DM. Esophageal atresia/tracheoesophageal fistula in very low-birth-weight neonates:improved outcomes with staged repair. J Pediatr Surg. 2009;44:2278–81.CrossRefGoogle Scholar
  2. 2.
    Stewart TE, Meade MO, Cook DJ, Granton JT, Hodder RV, Lapinsky SE, Mazer CD, McLean RF. Evaluation of a ventilatory strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med. 1998;338:355–61.CrossRefGoogle Scholar
  3. 3.
    Amato MBP, Barbas CSV, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA. Effect of a protective-ventilation strategy on mortality in the acute repiratory distress syndrome. N Engl J Med. 1998;338:347–54.CrossRefGoogle Scholar
  4. 4.
    ARDS Network Study. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.CrossRefGoogle Scholar
  5. 5.
    Hickling KJ, Henderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnoea in severe adult respiratory distress syndrome. Intensive Care Med. 1990;16:372–7.CrossRefGoogle Scholar
  6. 6.
    Tobin MJ, Laghi F, Jubran A. Ventilator-induced respiratory muscle weakness. Ann Intern Med. 2010;153(4):240–5.CrossRefGoogle Scholar
  7. 7.
    Graham MR , Goertzen AL, . Girling LG, Friedman T, Pauls RJ, Dickson T, Espenell AEG, Mutch WAC. Quantitative computed tomography in porcine lung injury with variable versus conventional ventilation: recruitment and surfactant replacement. Crit Care Med 2011;39(7):1721–1730.CrossRefGoogle Scholar
  8. 8.
    Brewster JF, Graham MR, Mutch WAC. Convexity, Jensen’s inequality and benefits of noisy mechanical ventilation. J R Soc Interface. 2005;2:393–6.CrossRefGoogle Scholar
  9. 9.
    Ventre KM, Arnold JH. High frequency oscillatory ventilation in acute respiratory failure. Pediatr Resp Rev. 2004;5:323–32.CrossRefGoogle Scholar
  10. 10.
    Froese AB, Kinsella JP. High-frequency oscillatory ventilation: lessons from the neonatal/pediatric experience. Crit Care Med. 2005;33:S115–21.CrossRefGoogle Scholar
  11. 11.
    Sud S, Sud M, Friedrich JO, Adhikari NK. Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Can Med Assoc J. 2008;178(9):1153–61.CrossRefGoogle Scholar
  12. 12.
    Sokol J, Jacobs SE, Bohn D. Inhaled nitric oxide for acute hypoxaemic respiratory failure in children and adults. Cochrane Database Syst Rev. 2003;(1):CD002787.Google Scholar
  13. 13.
    Edwards AD. The pharmacology of inhaled nitric oxide. Arch Dis Child Fetal Neonatal Ed. 1995;72(2):F127–30.CrossRefGoogle Scholar
  14. 14.
    Bahrami KR, Van Meurs KP. ECMO for neonatal respiratory failure. Semin Perinatol. 2005;29:15–23.CrossRefGoogle Scholar
  15. 15.
    Davis PJ, Firmin RK, Manktelow B, Goldman AP, Davis CF, Smith JH, Cassidy JV, Shekerdemian LS. Long-term outcome following extracorporeal membrane oxygenation for congenital diaphragmatic hernia: the UK experience. J Pediatr. 2004;144:309–15.CrossRefGoogle Scholar
  16. 16.
    Wilson JM, Lund DP, Lillehei CW, Vacanti JP. Congenital diaphragmatic hernia—a tale of two cities: the Boston experience. J Pediatr Surg. 1997;32(3):401–5.CrossRefGoogle Scholar
  17. 17.
    da Silva O, Stevens D. Complications of Airway Management in very-low-birth-weight infants. Biol Neonate. 1999;75:40–5.CrossRefGoogle Scholar
  18. 18.
    Weiss M, Gerber AC. Cuffed tracheal tubes in children-things have changed. Pediatr Anesth. 2006;16:1005–7.CrossRefGoogle Scholar
  19. 19.
    Weiss M, Dullenkopf A, Fisher JE, Keller C, Gerber AC, European Paediatric Endotracheal Intubation Study Group. Prospective randomised controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children. Br J Anaesth. 2009;103:867–73.CrossRefGoogle Scholar
  20. 20.
    Mahajan A, Shabanie A, Turner J, Sopher MJ, Marijic J. Pulse contour analysis for cardiac output monitoring in cardiac surgery for congenital heart disease. Anesth Analg. 2003;97:1283–8.CrossRefGoogle Scholar
  21. 21.
    Linton RA, Jonas MM, Tibby SM, Murdoch IA, O’Brien TK, Linton NWF, Band DM. Cardiac output measured by lithium dilution and transpulmonary thermodilution in patients in a paediatric intensive care unit. Intensive Care Med. 2000;26:1507–11.CrossRefGoogle Scholar
  22. 22.
    Brierley J, Carcillo JA, Choong K, Cornell T, DeCaen A, Deymann A, et al. Clinical practice parameters for haemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37:666–88.CrossRefGoogle Scholar
  23. 23.
    de Oliviera CF, de Oliviera DSF, Gottschald AFC, Moura JDG, Costa GA, Vaz FAC, Troster EJ. ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation. Intensive Care Med. 2008;34:1065–75.CrossRefGoogle Scholar
  24. 24.
    Finfer S, Bellomo R, Boyce N, et al. SAFE Study Investigators: a comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–56.CrossRefGoogle Scholar
  25. 25.
    Cunliffe M, Potter F. Four and a fifth and all that. Br J Anaesth. 2006;97(3):274–7.CrossRefGoogle Scholar
  26. 26.
    Mann C, Held U, Herzog S, Baenziger O. Impact of normal saline infusion on postoperative metabolic acidosis. Pediatr Anesth. 2009;19:1070–7.CrossRefGoogle Scholar
  27. 27.
    Macrae D, Grieve R, Allen E, Sadique Z, Morris K, Pappachan J, Parslow R, Tasker RC, Elbourne D. A randomized trial of hyperglycaemic control in paediatric intensive care. N Engl J Med. 2014;370:107–18.CrossRefGoogle Scholar
  28. 28.
    Valverde E, Pellicer A, Madero R, Elorza D, Quero J, Cabanas F. Dopamine versus epinephrine for cardiovascular support in low birth weight infants: analysis of systemic effects and neonatal clinical outcomes. Pediatrics. 2006;117:e1213–22.CrossRefGoogle Scholar
  29. 29.
    Hollenberg SM, Cunnion RE, Zimmerberg J. Nitric oxide synthase inhibition reverses arteriolar hyporesponsiveness to catecholamines in septic rats. Am J Physiol. 1993;264:H660–3.Google Scholar
  30. 30.
    Buijs EAB, Danser AHJ, Meijer NIF, Tibboel D. Cardiovascular catecholamine receptors in children: their significance in cardiac disease. J Cardiovasc Pharmacol. 2011;58:9–19.CrossRefGoogle Scholar
  31. 31.
    Bettendorf M, , Schmitt KG, Grulich Henn J et al. Tri-iodothyronine treatment in children after cardiac surgery; a double blind randomised placebo controlled study. Lancet 2000;356:529–534.CrossRefGoogle Scholar
  32. 32.
    Portman MA, Slee A, Olsonn AK, Cohen G, Karl T, Tong E, Hastings L, Patel H, Reinhartz O, Mott AR, Mainwaring R, Linam J, Danzi S. For the TRICC Investigators. Triiodothyronine supplementation in infants and children undergoing cardiopulmonary bypass (TRICC). Circulation. 2010;122(suppl1):S224–33.CrossRefGoogle Scholar
  33. 33.
    Ng PC, Lee CH, Bnur FL. A double blind, randomized controlled study of a stress dose of hydrocortisone for rescue treatment of refractory hypotension in preterm infants. Pediatrics. 2006;117:367–75.CrossRefGoogle Scholar
  34. 34.
    Seri I. Hydrocortisone and vasopressor-resistant shock in preterm neonates. Pediatrics. 2006;117:516–8.CrossRefGoogle Scholar
  35. 35.
    Overgaard CB, Dzavik V. Inotropes and vasopressors. Review of physiology and clinical use in cardiovascular disease. Circulation. 2008;118:1047–56.CrossRefGoogle Scholar
  36. 36.
    Copper DJ, Russell JA, Walley KR, et al. Vasopressin and septic shock trial (VASST) innovative features and performance. Am J Respir Crit Care Med. 2003;167:A838.Google Scholar
  37. 37.
    Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation. 2003;107:|996–1002.CrossRefGoogle Scholar
  38. 38.
    Ryerson LM, Alexander PMA, Butt WW, Shann F, Penny DJ, Shekerdemian LS. Rotating inotrope therapy in a paediatric population with decompensated heart failure. Pediatr Crit Care Med. 2011;12:57–60.CrossRefGoogle Scholar
  39. 39.
    Walters S, Porter C, Brophy PD. Dialysis and pediatric acute kidney injury:choice of renal support modality. Pediatr Nephrol. 2009;24:37–48.CrossRefGoogle Scholar
  40. 40.
    Sorof JM, Stromberg D, Brewer ED, Feltes TF, Fraser CD. Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol. 1999;13:641–5.CrossRefGoogle Scholar
  41. 41.
    DiCarlo JV, Auerbach SR, Alexander SR. Clinical review: alternative vascular access techniques for continuous hemofiltration. Crit Care. 2006;10:230. CrossRefGoogle Scholar
  42. 42.
    Pierro A, Eaton S. Metabolism and nutrition in the surgical neonate. Semin Pediatr Surg. 2008;17:276–84.CrossRefGoogle Scholar
  43. 43.
    Okada Y, Klein N, van Saene HK, et al. Small volumes of enteral feedings normalise immune function in infants receiving parenteral nutrition. J Paediatr Surg. 1998;33:16–9.CrossRefGoogle Scholar
  44. 44.
    Taylor CJ, Jenkins P, Manning D. Evaluation of a peptide formula (milk) in the management of infants with multiple GIT intolerance. Clin Nutr. 1988;7:183–9.CrossRefGoogle Scholar
  45. 45.
    Jawaheer G, Pierro A, Lloyd DA, Shaw NJ. Gall-bladder contractility in neonates-effects of parenteral and enteral feeding. Arch Dis Child. 1995;72:F200–2.CrossRefGoogle Scholar
  46. 46.
    Grover Z, Tubman R, McGuire W. Glutamine supplementation for young infants with severe gastrointestinal disease. Cochrane Database Syst Rev. 2007:CD005947.Google Scholar
  47. 47.
    Playfor S, Jenkins I, Boyles C, Choonara I, Davies G, Haywood T, Hinson G, Mayer A, Morton N, Ralph T ,Wolf A. United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group. Consensus guidelines on sedation and analgesia in critically ill children. Intensive Care Med. 2006;32:1125–36.CrossRefGoogle Scholar
  48. 48.
    Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database Syst Rev. 2003;(1):CD002052.
  49. 49.
    Wolf A, McKay A, Spowart C, Granville H, Boland A, Petrou S, Sutherland A, Gamble A. Prospective,multicentre,randomised,double-blind equivalence study comparing clonidine and midazolam as intravenous sedative agents in critically ill children the SLEEPS (safety profiLeEfficacy and equivalence in Paediatric intensive care sedation) study. Health Technol Assess. 2014;18:71.CrossRefGoogle Scholar
  50. 50.
    Lynn A, Nespeca MK, Bratton SL, Strauss SG, Shen DD. Clearance of morphine in postoperative infants during intravenous infusion:the influence of age and surgery. Anesth Analg. 1998;86:958–63.CrossRefGoogle Scholar
  51. 51.
    Arnold JH. High-frequency ventilation in the pediatric intensive care unit. Pediatr Intensive Care Med. 2000;1:93–9.Google Scholar
  52. 52.
    Neonatal Inhaled Nitric Oxide Study Group (NINOS). Inhaled nitric oxide and hypoxic respiratory failure in infants with congenital diaphragmatic hernia. Pediatrics 1997;99:838–845.Google Scholar
  53. 53.
    Bohn D. Congenital diaphragmatic hernia. Am J Respir Crit Care Med. 2002;166:911–5.CrossRefGoogle Scholar
  54. 54.
    Bősenberg AT, Hadley GP, Wiersma R. Oesophageal atresia: caudo-thoracic epidural anaesthesia reduces the need for post-operative ventilatory support. Pediatr Surg Int. 1992;7:289–91.CrossRefGoogle Scholar
  55. 55.
    Burden RJ, Shann F, Butt W, Ditchfield M. Tracheobronchial malacia and stenosis in children in intensive care: bronchograms help to predict outcome. Thorax. 1999;54:511–7.CrossRefGoogle Scholar
  56. 56.
    Calkoen EE, Gabra HOS, Roebuck DJ, Kiely E, Elliot MJ. Aortopexy as treatment for tracheo-bronchomalacia in children: an 18-year single-centre experience. Pediatr Crit Care Med. 2011;12:545–51.CrossRefGoogle Scholar
  57. 57.
    Morabito A, Owen A, Bianchi A. Traction-compression-closure for exomphalos major. J Pediatr Surg. 2006;41:1850–3.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Jackson Rees Department of Paediatric AnaesthesiaNHS Foundation Trust, Alder Hey Children’s HospitalLiverpoolUK

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