Survival of the weakest. Improving prospects for surgery in infants of birthweight less than 1,200 grams.

Over a six-year period seventeen infants of birthweight less than 1,200 grams (including nine of birthweight less than 1,000 grams) underwent major gastrointestinal surgery. Fourteen of the seventeen (82%) survived, a higher rate than previously reported. Nine infants had necrotising enterocolitis, three had oesophageal atresia and five had other types of intestinal obstruction. Six infants who were unfit to be transferred to the operating theatre underwent surgery on the neonatal unit: of these, four survived. We feel the outlook is optimised by conservative surgical intervention and by maximal medical support with intensive care monitoring, post-operative mechanical ventilation and intravenous alimentation. Survival after surgery is now very much the rule in the extremely low birthweight infant, even in those who are too sick to be transferred to the operating theatre.