Neonatal laparotomy
Clinical Procedure
 
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Be aware of the risk of liver rupture on decompression of the abdomen and have a plan ready for this.

This would likely involve administration of recombinant factor 7 so have this nearby.

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Ensure you have a reliable peripheral access port with an extension to administer volume and drugs.

Sort this out before surgical draping

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Intraarterial cannula is useful for perfusion monitoring as well as taking blood.

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Ensure endotracheal depth is confirmed ( with CXR if necessary ) and clear in your mind in case ventilation becomes difficult intraoperatively.

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Monitor serum calcium carefully to avoid hypocalcaemia.

Replacement of any deficit will improve myocardial contraction and coagulation.

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Coagulopathy is very common in unwell neonates with an acute abdomen.

Take note of preop coagulation status and have plan for preventative measures (normothermia, normal serum calcium etc) and treatment.

Consider discussing with a haematologist.

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Ensure the patient is placed on top of a forced air warmer

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Maintain a temperature > 35 degrees Celsius

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