Neonatal surgery refers to operations on children in the first month of life, almost always on an emergency or urgent basis. Many of these conditions are interesting and myriad, ranging from common in-born anomalies (cardio-vascular and gastro-intestinal) to fortunately rarer lethal conditions. All neonatal surgeries are undertaken by the senior staff in cooperation with the Specialist Neonatal Medical and Paediatric Anaesthesiology staff.
Neonatal surgical conditions which are best managed by pediatric surgeons include (in alphabetical order):
1. Abdominal wall defects including gastroschisis, omphalocele, and Pentalogy of Cantrell
2. Biliary atresia and choledochal cyst
3. Cloacal exstrophy
4. Conjoined twins
5. Cystic adenomatoid malformation of the lung and other types of bronchogenic cysts
6. Cystic hygroma and other neck masses
7. Diaphragmatic hernia
8. Duplication cysts and mesenteric cysts
9. Esophageal atresia with or without TE fistula (TEF)
10. Gastroesophageal reflux and hiatal hernia
11. Hirschsprung’s disease (megacolon)
12. Hydrometrocolpos and imperforate hymen
13. Imperforate anus including persistent cloaca
14. Inguinal hernias
15. Intestinal obstruction including duodenal atresia, annular pancreas, malrotation, midgut volvulus, intestinal atresia, meconium ileus and meconium peritonitis
16. Necrotizing enterocolitis
17. Ovarian cysts
18. Pyloric stenosis
19. Ribcage and sternal deformities
20. Teratoma (sacrococcygeal) and other tumors of the newborn
21. Umbilical anomalies including hernia, patent urachus, patent omphalo-mesenteric duct
22. Undescended testes
Many of these neonatal surgical problems are very rare, occurring in 1 in 5,000 to 1 in 25,000 live births. Pediatric surgeons have specialized training in treating these conditions, thus affording your baby the best possible outcome.
Neonatal Cardiothoracic Surgery
The goal of surgery in the neonatal period is complete repair of the heart defect whenever possible. Examples of some congenital defects that complete repair is offered for include:
In the normal heart there are two main vessels leaving the pumping chambers: the aorta, which carries blood to the body from the left side; and the pulmonary artery, which carries blood to the lungs from the right heart. In the defect known as Truncus, the two main vessels are fused into one large channel into which both pumping chambers empty.
Other Neonatal Surgery
Children born with single ventricle offer complex challenges, such as hypoplastic left heart syndrome. Other types of neonatal surgery include valve disorders and other complex disorders.
Hypoplastic Left Heart Syndrome
HLHS is a severe congenital heart defect in which the left side of the heart does not develop during pregnancy. This means the left ventricle (the pumping chamber that sends blood to the body) and the aorta (the main artery that carries the blood to the body) and the mitral and aortic valves are very small and cannot support life. HLHS is a severe congenital heart defect in which the left side of the heart does not develop during pregnancy. This means the left ventricle (the pumping chamber that sends blood to the body) and the aorta (the main artery that carries the blood to the body) and the mitral and aortic valves are very small and cannot support life. Surgical repair requires three stages to enable the single working chamber to do the work of two ventricles. The first stage, the Norwood I procedure is typically performed within the first 2 weeks of life. The second stage, the bi-directional Glenn, is typically performed before the infant is 6 months old. At two to three years old, the third, and final stage – the Fontan operation is completed.Rarely, the staged approach cannot be performed on an HLHS heart, and a Heart Transplant is performed.
In a normal heart, the tricuspid valve controls blood blow from the right atrium to the right ventricle. When a person has Ebstein’s anomaly, the leaflets of the tricuspid valve are not formed correctly, and the valve is located lower than normal.In a normal heart, the tricuspid valve controls blood blow from the right atrium to the right ventricle. When a person has Ebstein’s anomaly, the leaflets of the tricuspid valve are not formed correctly, and the valve is located lower than normal.The leaflets do not control the blood flow properly, resulting in a right ventricle that is too small, and a right atrium that is too large. There are varying degrees of severity of Ebstein’s anomaly, and there is usually an atrial septal defect.