Study: Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants.
Researchers at UTHealth Houston believe that delaying surgical inguinal hernia repair in preterm newborns until after discharge from the neonatal intensive care unit (NICU) reduces the likelihood of major adverse outcomes.
A study led by lead and corresponding author Martin L. Blakely, MD, MS, MMHC, a professor of surgery and pediatrics at McGovern Medical School at UTHealth Houston, investigated the safety of early vs. late surgical correction for preterm newborns with an inguinal hernia. The results were published today in the Journal of the American Medical Association.
“The biggest question we wanted to answer was, ‘Should we let these little babies go home to grow before we repair their inguinal hernia, or should we do it now?'” Blakely stated. “It is a common condition among premature infants, but they also have other health issues. If the inguinal hernia is not fixed before leaving the NICU, they would suffer health hazards, yet they are weak at this age, and general anesthesia might be difficult for them.”
An inguinal hernia is a noticeable protrusion in the groin region. It affects 30 percent of premature infants.
Between September 2013 and April 2021, researchers conducted the first randomized clinical trial addressing this neonatal surgical question at 39 trial sites in the United States. Of the 338 infants in the trial, 172 had surgery done right away, whereas 166 had surgery done later.
Infants under the early repair approach had their inguinal hernias repaired before being discharged from the NICU. In the late repair method, hernia repair was scheduled after discharge and 55 weeks postmenstrual age. Postmenstrual age includes both gestational age (weeks of development prior to birth) and postpartum age (weeks following birth). The American Academy of Pediatrics states that postmenstrual age is a frequent age measure for preterm newborns.
The trial’s findings revealed that infants who underwent a later surgical repair had a 97% chance of experiencing fewer adverse outcomes. Researchers also discovered that more than 10% of the hernias in the late repair group resolved, and none of these infants required surgery. Later repairs enable the infant to be discharged from the NICU more quickly.
Blakely said, “These findings will likely result in changes of clinical practice across the country. Until now, physicians have not had data to back up their decision to hold off on surgical repair. For years, there have been questions about what is best. Now we have solid data that later is better for most preterm infants.”
He stated that future research will look into how the research findings are applied in clinical practice.
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