Impact of surgical treatment on neonatal management in extremely low birth weight infants: Single-center retrospective study

• Recent advances in neonatal intensive care have improved survival outcomes in extremely low birth weight (ELBW) infants (birth weight < 1000 g). • Little is known about indications for surgery, clinical course, and recent trends in ELBW infants on NICUs who require surgical treatment. • The article compares mortality, morbidity, and clinical characteristics of ELBW infants who received surgical treatment at our hospital. • Recent advances in NICU care have expanded indications for surgical treatment in ELBW infants. • Survival rates of surgically treated ELBW infants in NICU may be improving, and NICU stays may be becoming shorter. Few studies have examined the details of extremely low birth weight (ELBW) infants (i.e., infants with a birth weight < 1000 g) on neonatal intensive care units (NICUs) who require surgical treatment. Therefore, we analyzed mortality, morbidity, and clinical variables in ELBW infants who received surgical treatments at our center from 2009 to 2022. All ELBW infants were included who received surgical treatment at our NICU from January 2009 to December 2022. We compared data from infants treated in the early (2009–2015) and late (2016–2022) periods and investigated trends in mortality, morbidity, and clinical variables. A total of 678 ELBW infants were admitted and cared at our neonatal center and 56 ELBW infants were received surgical treatment. The number of patients who received surgical treatment increased in the late period (10.4 % (36/345)) compared to the early period (6.33 % (20/316)) (early vs late period: p = 0.0398). The indications for surgery were expanded in late period compared to early periods. In the late period, the survival rate was higher (63.5 vs 75.0 %: early vs late period). No statistical difference was observed between the early and late period in the duration of the NICU stay. However, the duration of NICU stay in died patients were shorter compared to the survived patients (median (lower -upper quartiles):196.5 (166.75–261.25 vs 75.0 (49.0–183.5): early vs late period). The total number of surgical treatments which each patient received were higher in survived cases (median (lower -upper quartiles): 2.0 (2.0–4.0) vs 1.0 (1.0–2.0): survived vs died cases: p = 0.013). Recent advances in NICU care have expanded the indications for surgical treatment in ELBW infants. Survival rates appear to have improved. In more recent years, patients have increasingly undergone multi-step surgical treatment, which we consider to be a result of the improved the systemic status of infants in perioperative period. 3