this infant be discharged home? Could this procedure have been done as an
outpatient after discharge?
Due to the risk of incarceration of the hernia,
many of these procedures are scheduled just prior to discharge home from the
NICU. After the procedure, the infant is monitored in the NICU for
postoperative apnea for 24 hours and if there are no apneic events they are
Recently, there has been increasing pressure to
reduce length of stay. Many of these patients are now discharged home and
brought back as outpatients for their hernia repairs. Current recommendations
for postoperative admission vary depending on the gestational age at birth. In
the full-term infant, the current recommendation is to monitor for
postoperative apnea if they are less than weeks post-conceptual age. In the
preterm infant, these recommendations can vary from 50 to 60 weeks
post-conceptual age and are institution-specific. The risk for incarceration of
the hernia while waiting beyond this timeframe must be weighed against the risk
of postopera-tive apnea and the need for overnight admission to the hospital.
These risks vary and depend on other variables, including post-conceptual age,
gestational age, hemoglo-bin concentration, and home apnea monitoring. Each
case is unique and must be reviewed on a case-by-case basis to determine the
proper treatment course.