{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:38:29Z","timestamp":1785407909061,"version":"3.56.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Cotside laparotomy is often performed in critically ill neonates, but its indications over in-theatre laparotomy remain unclear. This is the first systematic review of published evidence, aiming to clarify the feasibility, safety, and indications for neonatal intensive care (NICU)-based laparotomy.<\/jats:p>\n                  <jats:p>A systematic review was conducted following PRISMA guidelines. Quantitative data on patient demographics and outcomes were extracted, and where possible, aggregated comparative analyses were performed. Qualitative thematic analysis was used to explore reported institutional experiences of cotside laparotomy.<\/jats:p>\n                  <jats:p>Eighteen studies were included, reporting data from 20 surgical sites across 10 countries, published from 1994 to 2024. Eight studies reported a comparator group of theatre-based laparotomies. In total, data on 418 cotside and 453 theatre laparotomies were included. Cotside cohorts had lower birthweight (approximately 1,305\u2009g vs. 2,941\u2009g, p\u2009=\u20090.016) and gestational age (approximately 29.5 vs. 34.3 weeks, p\u2009=\u20090.047). Postoperative adverse event rates were similar between neonates in each group (8.1%, 33\/407 vs. 6.8%, 30\/442; \u03c7\n                  2\u2009=\u20090.23, p\u2009=\u20090.63), as was in-hospital mortality (24.1%, 98\/407 vs. 25.3%, 112\/442; \u03c7\n                  2\u2009=\u20090.15, p\u2009=\u20090.70). Thematic analysis identified transfer-related events as a significant concern in babies operated in theatre, particularly endotracheal tube dislodgement and hypothermia, while cotside operating space constraints and disturbance to NICU activities were frequently cited issues. Decisions on surgical location were multifactorial and multidisciplinary, influenced by cardiorespiratory status and institutional factors. Formal institutional guidelines for cotside surgery were reported in only 33% (6\/18) of studies.<\/jats:p>\n                  <jats:p>Emergency cotside laparotomy is safe and feasible. Despite consisting of a higher risk population, mortality and morbidity are comparable to theatre-based surgery. Avoiding the risks of transfer may confer additional benefit. Large-scale, prospective studies are needed to clarify the indications for cotside operating.<\/jats:p>","DOI":"10.1055\/a-2767-4700","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:16:28Z","timestamp":1765325788000},"page":"043-051","source":"Crossref","is-referenced-by-count":2,"title":["Emergency Laparotomy in the Neonatal Intensive Care Unit: A Systematic Review of Indications and Outcomes"],"prefix":"10.1055","volume":"36","author":[{"given":"Simran","family":"Sehdev","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"O'Sullivan","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Blaise","sequence":"additional","affiliation":[{"name":"Department of Paediatric Anaesthesia, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK"},{"name":"Department of Early Life Imaging, St Thomas' Hospital, King's College London, Westminster Bridge Road, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraint","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Selman","sequence":"additional","affiliation":[{"name":"Department of Paediatric Anaesthesia, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"Yardley","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1016\/j.jpedsurg.2020.11.029","article-title":"Bedside laparotomy in newborns -a single institute experience","volume":"56","author":"K Herle","year":"2021","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"20","DOI":"10.47338\/jns.v2.32","article-title":"Bedside neonatal intensive care unit surgery- myth or reality!","volume":"2","author":"S Kumar Sinha","year":"2013","journal-title":"J Neonatal Surg"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"M Ouzzani","year":"2016","journal-title":"Syst Rev"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qual Res Psychol"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"F51","DOI":"10.1136\/fn.76.1.F51","article-title":"Use of neonatal intensive care unit as a safe place for neonatal surgery","volume":"76","author":"A WD Gavilanes","year":"1997","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s003830050410","article-title":"In-situ emergency paediatric surgery in the intensive care unit","volume":"13","author":"N F Fanning","year":"1998","journal-title":"Pediatr Surg Int"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1046\/j.1440-1754.1999.00364.x","article-title":"Laparotomy for necrotizing enterocolitis: intensive care nursery compared with operating theatre","volume":"35","author":"G Frawley","year":"1999","journal-title":"J Paediatr Child Health"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1055\/s-2005-866602","article-title":"Congenital diaphragmatic hernia: intensive care unit or operating room?","volume":"22","author":"P Lago","year":"2005","journal-title":"Am J Perinatol"},{"issue":"12","key":"ref10","first-page":"851","article-title":"Bedside laparotomy in the extremely low birth weight baby: a plea to bring the surgeon to the baby","volume":"9","author":"D Arbell","year":"2007","journal-title":"Isr Med Assoc J"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"105","DOI":"10.5144\/0256-4947.2008.105","article-title":"Surgical procedures performed in the neonatal intensive care unit on critically ill neonates: feasibility and safety","volume":"28","author":"M S Mallick","year":"2008","journal-title":"Ann Saudi Med"},{"issue":"10","key":"ref12","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1007\/s00383-012-3161-z","article-title":"Scope and feasibility of operating on the neonatal intensive care unit: 312 cases in 10 years","volume":"28","author":"N J Hall","year":"2012","journal-title":"Pediatr Surg Int"},{"issue":"08","key":"ref13","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1016\/j.jpedsurg.2014.01.052","article-title":"The outcome of critically ill neonates undergoing laparotomy for necrotising enterocolitis in the neonatal intensive care unit: a 10-year review","volume":"49","author":"N J Wright","year":"2014","journal-title":"J Pediatr Surg"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.pedneo.2014.10.003","article-title":"Operating room within the neonatal intensive care unit\u2013experience of a medical center in Taiwan","volume":"56","author":"Y L Wang","year":"2015","journal-title":"Pediatr Neonatol"},{"issue":"09","key":"ref15","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1055\/s-0036-1579649","article-title":"Bedside neonatal intensive care unit correction of congenital diaphragmatic hernia: is repair without compromise?","volume":"33","author":"T Altokhais","year":"2016","journal-title":"Am J Perinatol"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"18","DOI":"10.5472\/marumj.299382","article-title":"Making decisions for surgical intervention in neonates with necrotizing enterocolitis and the selection of appropriate surgical intervention","volume":"30","author":"K Karadeniz Cerit","year":"2017","journal-title":"Marmara Med J"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"368","DOI":"10.4103\/jiaps.JIAPS_165_19","article-title":"Surgery in the neonatal intensive care unit in Indian scenario: should it be \u201cthe new state of the art\u201d or just \u201cthe need of the hour\u201d?","volume":"25","author":"S Garge","year":"2020","journal-title":"J Indian Assoc Pediatr Surg"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"101663","DOI":"10.1016\/j.epsc.2020.101663","article-title":"Splenic rupture in an extremely low birthweight infant","volume":"63","author":"J Hammond","year":"2020","journal-title":"J Pediatr Surg Case Rep"},{"issue":"06","key":"ref19","first-page":"e16077","article-title":"Operating within the neonatal intensive care unit: a retrospective analysis from a tertiary care center","volume":"13","author":"S Anand","year":"2021","journal-title":"Cureus"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"436","DOI":"10.3892\/etm.2022.11363","article-title":"Neonatal intensive care unit on-site surgery for congenital diaphragmatic hernia","volume":"23","author":"A E Gaiduchevici","year":"2022","journal-title":"Exp Ther Med"},{"issue":"08","key":"ref21","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1177\/00031348221084941","article-title":"Congenital diaphragmatic hernia repair at the bedside or operating theater","volume":"88","author":"J A Niec","year":"2022","journal-title":"Am Surg"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1177\/02676591221147436","article-title":"Successful decompressive laparotomy in a neonate with abdominal compartment syndrome on extracorporeal membrane oxygenation following congenital diaphragmatic hernia repair","volume":"39","author":"C Plourde","year":"2024","journal-title":"Perfusion"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s00383-024-05937-0","article-title":"Advantage of bedside versus conventional operating room surgery in the management of term and preterm newborn infants: a single center retrospective observational study","volume":"41","author":"S Costa","year":"2025","journal-title":"Pediatr Surg Int"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1590\/S1807-59322011000400009","article-title":"Predictive score for clinical complications during intra-hospital transports of infants treated in a neonatal unit","volume":"66","author":"A LP Vieira","year":"2011","journal-title":"Clinics (Sao Paulo)"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1113627","DOI":"10.3389\/fped.2023.1113627","article-title":"Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery","volume":"11","author":"J Zhao","year":"2023","journal-title":"Front Pediatr"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5604\/01.3001.0015.9660","article-title":"Scoring system for predicting surgical-site infection in neonates and pediatric intensive care units \u2013 a preliminary study","volume":"95","author":"L Lumban Gaol","year":"2022","journal-title":"Pol Przegl Chir"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1055\/a-1009-6671","article-title":"Prediction of ECMO and mortality in neonates with congenital diaphragmatic hernia using the SNAP-II score","volume":"231","author":"F Kipfmueller","year":"2019","journal-title":"Klin Padiatr"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.jpedsurg.2020.05.013","article-title":"Neurodevelopmental and growth outcomes of extremely preterm infants with necrotizing enterocolitis or spontaneous intestinal perforation","volume":"56","author":"C Zozaya","year":"2021","journal-title":"J Pediatr Surg"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"fmac100","DOI":"10.1093\/tropej\/fmac100","article-title":"Vasoactive inotropic score as a predictor of mortality in neonatal septic shock","volume":"68","author":"S Demirhan","year":"2022","journal-title":"J Trop Pediatr"}],"container-title":["European Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2767-4700.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T23:42:04Z","timestamp":1768606924000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2767-4700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,9]]},"references-count":28,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,1,16]]},"published-print":{"date-parts":[[2026,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2767-4700","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0939-7248","1439-359X"],"issn-type":[{"value":"0939-7248","type":"print"},{"value":"1439-359X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,9]]},"published":{"date-parts":[[2025,12,9]]}}}