Where Should the Surgical Neonates be Nursed?

Surgical neonates need specialist medical and nursing care if their outcomes are to be improved. It needs a team of pediatric surgeons, neonatologists, pediatric anesthetists, and trained nurses. However, a key question in the management of these neonates is the place where they should be managed. A recent survey of neonatal surgical units in the UK in 2008 [1] revealed that surgical neonates were managed in a variety of wards – neonatal medical ICUs, Pediatric intensive care units, stand alone neonatal surgical units and pediatric medical/surgical wards. In most centers in the survey there was a flexible use of these wards and in most pediatric centers 2-3 flexible locations were used for the preand postoperative care of surgical neonates. The survey revealed that there were only 8 stand alone neonatal surgical units of the 64 pediatric surgical facilities surveyed. This scenario would be akin to the situation existing in most large hospitals in India which cater to neonatal surgical patients. While many may consider this an efficient way of utilizing available resources, it significantly dilutes the medical and nursing care provided to these neonates due to lack of specialized training by these personnel. Given the rarity of many of these surgical conditions, location of these neonates in range of wards will dilute the training of medical and nursing personnel in the care of these babies. In fact a report on the surgical care of neonates published by the British association of pediatric surgeons and the Royal College of Surgeons strongly recommended that surgical neonates should be concentrated in specialist pediatric surgical units which are adequately staffed with trained pediatric surgeons, medical and nursing personnel and adequate equipment to care for these infants. In the case of preterm infants and those with complex congenital malformations it recommended a multi-disciplinary approach especially involving neonatologists and specialist in perinatal medicine/obstetricians [2].