Once the decision to operate has been made, the baby will be prepared for surgery. Premature infants are fragile in some respects, but with sufficient preparation most can tolerate major procedures. In fact, the major risk of surgery is due to the underlying medical problem, not the surgery itself.
To prepare a baby for surgery, the NICU staff:
- balances the baby's fluids;
- optimizes the baby's breathing; and
- provides adequate nutrition.
Each of these tasks is explained below.
Balancing Body Fluids
Body fluids (blood and the fluid in and around cells) make up more than three-quarters of a premature infant's weight. It is very important that a baby is adequately hydrated and that the chemicals in the body fluids are properly balanced before a baby undergoes the stress of surgery. Since most premature babies requiring surgery are not eating normally, the NICU staff balances body fluids through an intravenous (IV) line.
There are two kinds of IV lines:
- A peripheral line is placed in a vein in the arm, hand, foot, leg, or scalp. These lines are difficult to maintain because of the small size of the baby's veins.
- A central line (also called a PIC line, a Broviac line, or a Hickman line) is inserted through the arm, groin, or neck and extends to a tip near the baby's heart. The advantages of a central line over a peripheral line are that it can be maintained for a longer time, blood can be drawn through the line (instead of sticking the baby with another needle), stronger medications can be given through the line, and it can be used to feed the baby. A central line may be inserted at the bedside or in other settings.
To check for fluid volume, the NICU staff measures the amount of urine a baby produces. To check for fluid balance, the baby's blood is sent to the lab, where certain chemicals-such as sodium, potassium, chloride, carbon dioxide, glucose, creatinine, and blood urea nitrogen-are measured. If these chemicals are not in balance, the staff tries to correct them before an operation, though, the urgency of the surgery can sometimes make this impossible.
Optimizing the Baby's Breathing
The lungs are one of the last organs to mature. A baby born at less than 32 weeks (gestation) may develop breathing problems and require ventilator support. The NICU staff spends a great deal of effort tuning a baby's breathing (by adjusting the ventilator) to maximize lung function before an operation. Babies born at 34 weeks or later usually have fully functioning lungs.
Providing Adequate Nutrition
The NICU staff makes sure that the baby is in the best nutritional shape possible before surgery. This is often a challenge in premature babies because their ability to eat or digest food may be impaired.
Fortunately, total parenteral nutrition (TPN) can significantly improve a baby's nutritional status. TPN involves administration of a fluid containing the necessary nutrients through a central line. Usually, a baby who is sick enough to need surgery is too unstable to receive enteral feedings (breast milk or formula) until he has begun to recover after surgery.
After surgery, the staff focuses on the same three areas described above. Balancing body fluids and getting enough nutrition are even more challenging after surgery because a baby's intestines (even when not operated on) may not function optimally for a number of days after surgery. A central line is often important to ensure adequate nutrition.
Your baby is monitored in the NICU as usual and is watched for signs of complications or improvement.