Introduction During the last quarter of a century, new surgical techniques in neonates have been introduced, and neonatal intensive care has developed. Few studies have explored the implementation of new techniques and if outcomes in neonates undergoing gastrointestinal surgery have improved in the last decades. Therefore, this study aimed to investigate possible changes in postoperative outcomes and surgical techniques in all neonates operated for congenital duodenal obstruction (CDO) 1995-2020 in Norway. Material and methods This is a national multi-center retrospective study of all neonates undergoing surgery for CDO in Norway from 1995 to 2020. Results from three periods (1995-2003, 2004-2012, and 2013-2020) were compared. The study was approved by the local data protection officers (2020/13386) and (2020/15125). Results We included 186 patients: 41 in period 1 (1995-2003), 83 in period 2 (2004-2012), and 62 in period 3 (2013-2020). Seventy (38%) neonates had Down syndrome and 104 (62%) had additional malformations/disorders. Birth weight, gender, frequency of Down syndrome, and other malformations/disorders did not differ between the three periods. We observed an increased rate of prenatal diagnosis throughout the study period (p<0.001). The only change in surgical technique was increased use of transanastomotic feeding tubes (p<0.001). Length of stay, postoperative complication rate, days with parenteral nutrition, and 30-day mortality rate were stable over time. Conclusion Perioperative treatment and postoperative outcomes in neonates with CDO have been surprisingly unchanged during the last quarter of a century. Only an increased rate of prenatal diagnosis and more frequent use of transanastomotic feeding tubes were observed.

Purpose: This study aimed to investigate to what extent perioperative routines for treating neonates with congenital duodenal obstruction (CDO) aligned with the proposed Enhanced Recovery After Surgery (ERAS) recommendations for neonates and whether treatment highly corresponding with ERAS improves postoperative outcomes. Method: This is a cohort study of neonates undergoing surgery for CDO at Oslo University Hospital (2009-2020). Data were reviewed in 2022 and compared with the ERAS recommendations; high correspondence was defined as treatment corresponding with >70% of the recommendations. Results: Of 69 included neonates with CDO, 19 (28%) received treatment highly corresponding with the ERAS recommendations, and the overall median correspondence rate was 62.5 (14-88) %. Forty-two (65%) neonates received opioid treatment postoperatively; median total morphine equivalents were 0.1 mg/kg. Neonates in the high correspondence group received fewer morphine equivalents (p=0.027), but no significant differences were seen in terms of postoperative length of stay and complication rate. The overall correspondence with ERAS recommendations increased during the study period (p<0.001). Conclusion: Many of the ERAS recommendations have been a part of the treatment of neonates with CDO during the last decade. Neonates with treatment highly corresponding to ERAS recommendation received less opioid treatment than neonates with low correspondence.