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

Infographic · Oct 2024 · 1 min read

In brief

ERAS Society developed 16 evidence-based recommendations for perioperative care of surgical neonates in NICUs, covering team communication, fasting protocols, temperature management, antibiotic prophylaxis, ventilation, fluid management, and parental involvement. The guidelines apply across varied surgical pathology during the first 28 days of life.

ERAS guidelines for neonates cover 16 recommendations across 11 areas including fasting, temperature, antibiotics, and ventilation.
Unit-wide ERAS protocols can be applied to all surgical neonates in NICUs regardless of specific surgical pathology.
Insufficient evidence exists to recommend routine use of nasogastric tubes, Foley catheters, or central lines in neonatal surgery.
Multidisciplinary consensus (surgeons, anesthesiologists, neonatologists, nurses) drives evidence-based neonatal perioperative care.
Key focus areas include glucose control, fluid management, transfusion thresholds, early enteral feeds, and parental involvement.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with accompanying text boxes below describing outcomes. The left column shows balloon dilation, the middle shows Heller myotomy, and the right shows POEM procedure. Success rates are prominently displayed with percentage figures.

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

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