Current progress in neonatal surgery

Abstract

Neonatal surgery is the most specialized and sophisticated field of pediatric surgery. I herein review esophageal atresia, abdominal wall defects, gastrointestinal perforation, and congenital diaphragmatic hernia (CDH) as representative types of neonatal surgery. The clinical results of esophageal atresia have been considered to reflect the level of medicine of an individual country. Owing to an early diagnosis, improved operative techniques, and better perioperative management, the mortality rate has now become almost 0%. In addition, a minimally invasive thoracotomy is considered to improve long-term quality of life. The overall mortality rate of neonatal surgical disease has markedly decreased and is now less than 10%. However, abdominal wall defects, gastrointestinal perforation, and CDH still show a high mortality rate. A high incidence of chromosomal anomalies results in a poor outcome for abdominal wall defect. A gastrointestinal perforation in an infant complicated with an extremely how birth weight shows a high mortality rate. In CDH, pulmonary hypoplasia as well as pulmonary hypertension often causes an acute respiratory and circulatory deterioration after birth. Neither intensive care for pulmonary hypertension, including ECMO, nor fetal intervention has yet achieved a satisfactory outcome. Permissive hypercapnea and a delayed operation aiming at circulatory stabilization have resulted in a good survival rate. However, CDH survivors may be at risk for long-term morbidities. The method to induce pulmonary development is considered to be mandatory to achieve a good quality of life for severe CDH.

Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn

“…This overall mortality, relating to a surgical PICU population of risk, is within the prevalence reported for developed countries, which is usually below 10% 13 . To place results in context, nowadays, global neonatal surgical mortality is variable, especially depending on the level of development of the country.…”

A 3 years’ Experience of Operated Surgical Neonates Outcome in a Tertiary Hospital of Ain Shams University (Neonatal Intensive Care Unit)

“…Apart from the delayed presentation as in our study, we can attribute this high figure to the overcrowded nature and poor ventilation of the special care baby room (resuscitaire). On the other hand, the study done in Intensive Care Unit of the Coimbra's Pediatric Hospital Portugal; Europe by Catré et al (2014) (7) found that there was an overall mortality of 6.4% and according to (Taguchi, 2008) (12) this mortality relating to a surgical NICU population of risk, is within the prevalence reported for developed countries, which is usually below 10% the most common cause of death in Portugal is Peritonitis/Abdominal sepsis 42% while sepsis represented 7%. In the current study, (18.84%) of neonates had positive blood cultures while (81.16%) had no growth and the most common organism was Klebsiella 46% then Acetobacter 23% then E coli 7%, and non-hemolytic streptococci 7%, Pseudomonas 7% and Staphylococcus aureus (coagulase negative ) 7%.…”

The utility of muscle sparing axillar skin crease incision for pediatric thoracic surgery

“…The mortality rate has become less than 10% [1]. It is now important to consider the long-term good ''quality of life'' (QOL) in neonatal surgical disease.…”