Neonatal Emergencies II: Necrotizing Enterocolitis and Abdominal Wall Defects

Recent advances in perinatal care have dramatically improved the survival of the youngest and smallest infants, including critically ill neonates and those born with congenital malformations. This has increased the neonatal population at risk for intraabdominal diseases due to prematurity that require surgical intervention. Thus, the pediatric anesthesiologist is increasingly confronted with the challenging task of providing anesthetic care for these vulnerable patients. Despite our better understanding of the immature transitional physiology and developmental pharmacology, pathology of the diseases of prematurity and impact of surgery and anesthesia on their fragile homeostasis, the risk for adverse perioperative events is still the highest in neonatal patients. Therefore, thoughtful preparation, anticipation of potential complications, and efficient collaboration within the multidisciplinary team are essential to ensure safety and quality of the delivered anesthetic care. This review focuses on the perioperative management of necrotizing enterocolitis and abdominal wall defects, with emphasis on preoperative stabilization and tailoring of anesthetic intraoperative plan to the unique neonatal physiology and disease process. This review contains 4 tables, and 50 references. Key Words: anesthesia, necrotizing enterocolitis, gastroschisis, omphalocele, neonatal, prematurity, resuscitation, morbidity, mortality.