E. M. Knott1, K. W. Schnell1, B. J. Pieters2, S. D. St. Peter1 1Children’s Mercy Hospital,Pediatric Surgery,Kansas City, MO, USA 2Children’s Mercy Hospital,Department Of Anesthesiology,Kansas City, MO, USA
Introduction:
Wide variation exists in criteria for overnight observation after inguinal hernia repair in former premature infants. We previously compiled retrospective data to demonstrate the risk of overnight apneic events. In order to validate these findings we initiated prospective observational study to capture the true event rates.
Methods:
After institutional review board approval, we have followed all premature infants admitted for overnight observation after inguinal hernia between 7/1/11 to 7/31/14. Children under an adjusted gestational age (AGA) of 60 weeks were admitted for observation. Patients undergoing hernia repair while inpatient in the intensive care nursery were excluded. Demographic data was collected. The lowest heart rate and oxygen saturation after leaving the recovery room were noted. Episodes of apnea, bradycardia and desaturation were recorded.
Results:
To date, 96 patients have been accrued. AGA was 48.0 ± 5.5 weeks; 88.5% were male with an average weight of 4.7 ± 1.0 kg. Bilateral hernia repair was performed 55.2% of the time; laparoscopic repair was performed in 4.2%. Average length of stay was 24.1 ± 5.3 hours. While no patient had a recorded apneic episode, 1 was readmitted the night on postoperative day 1 for a witnessed episode of apnea after discharge. The 5 patients that had either bradycardia or desaturation are summarized in Table 1. Two of the 5 were on a home monitor. One had neurologic impairment and another had coarctation of the aorta; the remaining 3 had no significant comorbidities. No patient had more than one episode of either bradycardia or desaturation.
Conclusion:
The majority of postoperative episodes of bradycardia or desaturation are seen in infants undergoing inguinal hernia repair at less than 50 weeks adjusted gestational age. These events are short lived, resolve with supplemental oxygen and do not delay discharge. Lowering the AGA to 50 weeks or less for admission after inguinal hernia repair is supported by these data.
