Journal of Neonatal Surgery

Amyand hernia with perforated appendix simulating as testicular torsion in a neonate: A case report

Obay Edan — Sun, 31 Dec 2023 00:00:00 -0500

Background: Amyand hernia is defined as the presence of the vermiform appendix within the hernial sac. A perforated appendix is an uncommon complication of Amyand hernia. Rarely it may simulate a testicular torsion.

Case Presentation: A twenty-five-day-old male infant presented with right-sided scrotal swelling, exhibiting symptoms of crying, irritability, and poor feeding over a two-day duration. The swelling was non-reducible, confined to the scrotum, and the spermatic cord showed thickening with erythematous scrotal skin. Following preparation, an inguinal incision was made, and an appendectomy and herniotomy were performed.

Conclusion: Amyand hernia, a rare type of inguinal hernia, poses challenges in preoperative diagnosis. The occurrence of a perforated appendix is especially rare in neonates with Amyand hernia. Surgical management entails appendectomy through an inguinal incision coupled with meticulous hernia repair.

Jarcho Levin Syndrome with open neural tube defect: A case report

Md Mokarram Ali, Yogender Singh Kadian, Saima Ejaz, Arnav Kadian — Mon, 26 Feb 2024 00:00:00 -0500

Background: Jarcho Levin syndrome is a rare genetic disorder characterized by spine abnormalities and the absence of ribs. It is associated with various congenital malformations and carries significant morbidity and mortality. The simultaneous presentation of this syndrome with neural tube defects is seldom encountered.

Case Presentation: We report a case of a 2-day-old male who presented with a lesion on his back since birth. Clinical and radiological examinations revealed thoracolumbar meningomyelocele with the absence of upper ribs on the right side and a patent foramen ovale. Subsequently, the patient underwent surgery for meningomyelocele, while the rib anomalies were managed conservatively.

Conclusion: Jarcho Levin syndrome is a rare disorder, and its association with meningomyelocele is extremely uncommon. It should be considered in the evaluation of a patient with a neural tube defect and respiratory distress.

Double-blind ureteral duplication- a rare cause of a neonatal abdominal cyst: A case report

Thu, 30 May 2024 00:00:00 -0400

Background: Double-blind ureteral duplication (DBUD) is a rare condition in which one of the ureters in a duplicated system has no communication with the bladder or the renal pelvis.

Case Presentation: We present a neonatal case of DBUD in a newborn girl, associated with a non-functional kidney, initially identified as an abdominal cystic anechoic mass during antenatal ultrasound. A stepwise diagnostic and management approach was undertaken, including prenatal and postnatal imaging, multidisciplinary consultation, and surgical intervention.

Conclusion: Establishing a diagnosis of DBUD requires a systematic approach, incorporating comprehensive prenatal and postnatal assessments. This case is the first reported instance of DBUD diagnosed and treated in the neonatal period, highlighting the importance of early detection and intervention.

Unveiling neonatal intestinal obstruction due to total colonic atresia: A case report

Fawad Mueen Arbi, Muhammad Zulfiqar Anjum, Zeeshan Iqbal, Seerat Fatima — Fri, 26 Apr 2024 00:00:00 -0400

Background: Total colonic atresia is an uncommon congenital anomaly associated with neonatal intestinal obstruction, often necessitating prompt diagnosis and surgical intervention to prevent life-threatening complications. Understanding the etiology and optimal management strategies is crucial for ensuring favorable outcomes.

Case Presentation: We present a case of a full-term male neonate with total colonic atresia, who presented with failure to pass meconium, abdominal distension, and vomiting. Diagnostic imaging confirmed intestinal obstruction, leading to surgical exploration revealing an atretic colon extending from the Ileocolic Junction to the Rectosigmoid Junction. An ileostomy was performed, followed by meticulous postoperative care, resulting in a successful resolution of symptoms and discharge from the hospital.

Conclusion: Timely recognition and staged surgical management are paramount in addressing total colonic atresia, emphasizing the importance of early intervention for optimal patient outcomes. Long-term follow-up and comprehensive care are essential to ensure the overall well-being of affected newborns.

A remarkable case of intrauterine intussusception, ileal atresia, and complicated meconium ileus: A case report

Jonathan Hencke, Oliver Diez, Steffan Loff — Tue, 07 May 2024 00:00:00 -0400

Background: Intrauterine intussusception, although very rare (<2%), is a potential cause of intestinal atresia. It usually manifests as bowel obstruction during the first hours or days of life.

Case Presentation: We report a case with fetal ascites prompting early Cesarean section, with subsequent percutaneous abdominal drainage and laparotomy. Intraoperative findings showed meconium peritonitis and type IIIa ileal atresia with intussusception of the distal part, with the necrosed intussusceptum likely causing perforation and ileal atresia; in addition, the distal ileum demonstrated signs of meconium ileus. After ileostomy creation, the postoperative course was uneventful. Cystic fibrosis was excluded via a sweat test.

Conclusion: Prompt diagnosis and management of neonatal intestinal obstruction secondary to the unusual combination of fetal ascites, intussusception, complicated meconium ileus, and ileal atresia results in a favorable outcome.

Situs ambiguous with duodenal atresia in a neonate: A case report with literature review

Obay Edan — Sat, 20 Jul 2024 00:00:00 -0400

Background: Situs ambiguous is a rare congenital anomaly characterized by an unusual and irregular distribution of the major visceral organs and vessels within the chest and abdomen. In this condition, the organs are arranged in a way that cannot be classified as either situs inversus or situs solitus. We report this case due to the rarity of this anomaly and its uncommon association with duodenal atresia in a neonate.

Case Presentation: A full-term newborn female presented with repeated bilious vomiting and failure to pass meconium for five days. An erect abdominal X-ray revealed a double-bubble sign in the left hemiabdomen, and a CT scan confirmed an abnormal relationship between the liver and stomach. Operative exploration confirmed the diagnosis of situs ambiguous with duodenal atresia, which was treated with a diamond duodenoduodenostomy.

Conclusion: Situs ambiguous is a rare variant of situs anomaly with few reported cases worldwide. It has two subtypes: left and right isomerism, based on the anatomy of the spleen. Clinically, it can present with features of intestinal obstruction when associated with duodenal atresia.

Neonatal intestinal obstruction secondary to Meckel's diverticulum with associated band and ileal stricture: A case report with review of literature

Sun, 11 Aug 2024 00:00:00 -0400

Background: Symptomatic Meckel’s diverticulum is exceptionally rare in neonates, often presenting as intestinal obstruction or perforation. The differential diagnosis may encompass more prevalent conditions like intestinal atresia, malrotation, or Hirschsprung's disease.

Case Presentation: We present a case of a 21-day-old female who presented with intestinal obstruction. Exploratory laparotomy revealed Meckel's diverticulum with a mesodiverticular band causing closed-loop obstruction along with three passable strictures in the ileum. Surgical resection of the affected bowel and the creation of an ileostomy were performed due to bowel ischemia and hemodynamic instability.

Conclusion: Early diagnosis and prompt surgical intervention are pivotal in managing neonatal Meckel's diverticulum, reducing risks of bowel necrosis and complications.

A rare presentation of antenatally diagnosed Wilms tumor: A case report

Pradeep Kajal, Namita Bhutani, Bhaswati Bharadwaj — Mon, 05 Aug 2024 00:00:00 -0400

Background: Wilms’ tumor is the most common renal malignancy in children, with a peak incidence between 1 and 4 years of age. The prevalence of antenatal renal tumors is scarce, around 7 in 100,000 live births. We report a case of an antenatally diagnosed Wilms tumor.

Case Presentation: A 2-month-old infant presented with a right renal lump since birth. The antenatal USG done at 35 weeks of gestation, showed an ill-defined heteroechoic area of size 57.3X29.9 mm at the upper pole of the right kidney, with few cystic areas with increased echogenicity. A right nephroureterectomy was done. It was WT1 and Vimentin positive and focally positive for Cyclin D1, whereas negative for Desmin, SMA, and PAX8, thus confirming the histopathological diagnosis of Wilms’ tumor.

Conclusion: Antenatal Wilms’ tumor is rarely detected. A high degree of suspicion and active investigations should be conducted in antenatal and immediate neonatal periods for prompt decision-making and better outcomes.

Intestinal malrotation with levocardia and Spondylo-costal dysostosis: A case report

Tue, 17 Sep 2024 00:00:00 -0400

Background: Intestinal malrotation with midgut volvulus is usually present in the neonatal period but can present at any age, and can be associated with various congenital anomalies. These congenital defects increase the morbidity of the disease per se and require a multidisciplinary approach.

Case Presentation: The index case was an eight-month-old child with intestinal malrotation, situs inversus, levo-cardia, single ventricle, and Spondylo-costal dysostosis. Here, we discuss its presentation, treatment, challenges during management, and review of pertinent literature.

Conclusion: The association of intestinal malrotation with situs inversus, levocardia, and SCD requires further reporting as well as genetic studies to understand its embryo pathogenesis. The multidisciplinary team is essential for the ideal treatment of this type of complex case.

Patent vitello-intestinal duct with a rare presentation of reverse intussusception with appendicular agenesis: A case report

Aman Kumar Singh, Manoj Gogoi, Bhaswati Bharadwaj — Sun, 22 Sep 2024 00:00:00 -0400

Background: Vitello-intestinal duct (VID) is found in approximately 2% of newborns, with patency in about 6%. Failure of obliteration leads to some anomalies, most commonly Meckel’s diverticulum. Protrusion of the small bowel is one of the rare presentations.

Case Presentation: A 10-month-old male infant presented with a prolapsed, irreducible polypoid-shaped loop of intestine protruding from the anterior abdomen. On exploratory laparotomy, patent VID was confirmed with appendicular agenesis and reverse intussusception. Gangrenous bowel was resected, followed by end-to-end ileo-ileal anastomosis, with a favorable outcome.

Conclusion: Patent VID with ileal intussusception and prolapse is a rare entity, which can be easily diagnosed clinically. A high index of suspicion is needed for any associated gut anomaly in these cases, like appendicular agenesis.

Perioperative fluid and electrolyte management in surgical neonates

Nitin James Peters, Shivani Dogra, Sandhya Yaddanapudi, Jai Kumar Mahajan — Sun, 31 Dec 2023 00:00:00 -0500

Neonates with surgical conditions may experience significant electrolyte abnormalities and dehydration of varying degrees. Increased awareness of perioperative hyponatremia and its associated morbidity has led to a shift in Pediatric fluid guidelines favoring the use of isotonic fluids. However, there is a lack of evidence-based guidelines for neonatal perioperative fluid administration, resulting in the extrapolation of fluid management principles from adults and children. This article reviews perioperative neonatal fluid management.

On the curious association of diaphragmatic hernia and Urban-Rifkin-Davis Syndrome (Autosomal Recessive Cutis Laxa-1C): A collective review of 16 cases

V Raveenthiran, Nagarajan Darun, Dhayalan Pavithra, Prakash Gambhir — Fri, 22 Mar 2024 00:00:00 -0400

Background: Autosomal recessive cutis laxa type-1C is also known as Urban-Rifkin-Davis syndrome (URDS). It is known to affect cardiopulmonary, integumentary, gastrointestinal, musculoskeletal and genitourinary systems. However, its frequent association with congenital diaphragmatic hernia has not previously been highlighted.

Case Presentation: A newborn male with cutis laxa presented with respiratory distress at birth. The cause of dyspnoea was perinatal strangulation of the stomach in hiatus hernia. After surgical repair of the hernia, his respiratory distress temporarily improved but kept recurring periodically by various mechanisms in sequence namely pulmonary hypertension, tracheomalacia, pulmonary emphysema and finally he succumbed to pneumothorax. Genetic analysis revealed his skin condition as autosomal recessive cutis laxa type-1C which is also known as URDS. Exome sequencing revealed a novel frameshift mutation c.426delC (p.Cys143Alafs*41) of the LTBP4 gene in the exon 5 of Chromosome 19.

Conclusion: Out of the 28 cases of URDS reported in the world literature 57% had congenital diaphragmatic hernia (CDH) and 53% of them died during infancy. Such a high incidence of CDH is not observed in other subtypes of elastic disorders. Thus, congenital diaphragmatic defects appear to be a characteristic diagnostic feature of URDS in patients with cutis laxa.

Scrotoschisis: Review in clinical and embryological perspective of a rare anomaly

Erjan Fikri, Ahmad Razi Maulana Alnaz, Aqyl Hanif Abdillah, Salsabila Az-Zahra — Mon, 25 Mar 2024 00:00:00 -0400

Scrotoschisis is a rare congenital anomaly affecting the scrotum and testes, characterized clinically by a defect in the scrotal wall and extrusion of testicular tissue. This literature review is based on reports gathered from PubMed, Science Direct, and Google Scholar using relevant keywords to explore the underlying basic science of this rare condition. The etiology and mechanism of scrotoschisis development remain largely unknown, with only theoretical explanations and a lack of empirical evidence regarding its pathogenesis, which is thought to be linked to embryological abnormalities during scrotal formation. Diagnosing scrotoschisis typically involves a straightforward visual examination of the extruded testes immediately after birth, although clinical presentations may vary, being either unilateral or bilateral. Surgical intervention, primarily through orchidopexy, is generally beneficial for repositioning the testes, closing defects, and preventing potential complications. The prognosis for individuals with this anomaly is generally favorable, although long-term testicular function has been inadequately documented. Further research, including additional clinical reports and investigations involving animal models or embryological studies, is warranted to enhance our understanding of this condition.

Artificial intelligence and writing: What ChatGPT says?

Muhammad Bilal Mirza — Sun, 31 Dec 2023 00:00:00 -0500

Extremely low birth weight (ELBW) neonates for emergency surgery- A challenge for the Anesthesiologist: A case series

Preeti Goyal Varshney, Madhurima Sinharay, Anshu Gupta, Maitree Pandey — Thu, 14 Mar 2024 00:00:00 -0400

Background: Extremely Low Birth Weight (ELBW) newborns, defined as those with a birth weight of 1000 grams or less, present challenging anesthetic scenarios. Emergency surgeries in these infants elevate their vulnerability to various complications.

Case Presentation: We present a case series involving 5 ELBW neonates who underwent emergency surgery. Three of them were at a post-conceptual age (PCA) of ≥ 33 weeks and underwent procedures for congenital birth defects, including esophageal atresia, ileal atresia, and gastroschisis. The remaining two neonates, with a PCA of 29-30 weeks, underwent surgery for necrotizing enterocolitis (NEC).

Conclusion: The compromised physiology resulting from distinct disease processes and the underdeveloped systems of ELBW preterm neonates necessitate focused care and strategic anesthesia. This approach is crucial to mitigate morbidity and mortality risks in such vulnerable patients.

Single-center experience of fetus in fetu: A case series

Sat, 13 Apr 2024 00:00:00 -0400

Background: Fetus in fetu is a rare congenital malformation resulting from abnormal embryogenesis in a monochorionic diamniotic twinning gestation. This study aimed to document our experience with this anomaly in a developing country.

Methods: This retrospective analysis covers cases of fetus in fetu diagnosed at our institution between 1999 and 2023. Patients presenting with an intracorporeal mass containing a vertebral column and an appropriate arrangement of organs and limbs around the axis were included in the study.

Results: Five female patients with fetus in fetu were identified. The timing of diagnosis varied from incidental antenatal ultrasound discovery to postnatal abdominal mass presentation. The initial diagnosis involved radiological and serological investigations, confirmed by histopathology after surgical excision. The mean age at the time of surgery was 44 days. All patients underwent complete excision of the fetal mass, resulting in excellent postoperative outcomes and no recurrences.

Conclusion: Fetus in fetu is a pediatric rarity and must be distinguished from a teratoma mass, which carries a high malignant potential. Histological and genetic studies may contribute to understanding the pathogenesis and etiology of the disease.

Apple-Peel intestinal atresia: A systematic review

Tue, 14 May 2024 00:00:00 -0400

Background: Apple-peel bowel atresia (APA) is rare and thus lacks proper management guidelines. This systematic review analyzes various interventions found in the literature for this type of atresia and highlights the outcomes of each intervention with their complications.

Methods: The relevant literature on PubMed, Scopus, Embase, and Cochrane was reviewed from November 2020 to January 2021. Articles published in English, French, Italian, or Spanish between 1990 and 2020, focusing on APA, were included. Data on demography, clinical profile, management provided, time to achieve full feed, length of hospital stay, complications, etc., reviewed.

Results: A total of 2495 articles were found, of which only 48 met the inclusion criteria. Among these, 125 patients were treated, with 15 deaths. The most frequently employed intervention was primary resection, with or without tapering, while ostomy creation was less commonly used. The most frequent complication across all techniques appeared to be cholestasis, followed by stenosis of the anastomosis and sepsis. Additionally, there were a total of 7 cases of short bowel syndrome (SBS).

Conclusion: The management of apple-peel atresia seems variable in various centers of different countries. The review failed to assess which interventions could lead to faster full enteral feeding. The distal part of the anastomosis must be considered as an active part in the resumption of bowel function.

Inguinal hernia repair in newborns: A systematic literature review

Mon, 20 May 2024 00:00:00 -0400

Background: Inguinal hernia (IH) is a prevalent condition in children necessitating surgical repair. However, determining the optimal timing (early or delayed) of inguinal herniotomy in neonates and preterm infants remains debatable. While open herniotomy traditionally serves as the standard inguinal hernia repair (IHR) procedure, laparoscopic repair has gained traction in recent decades. Our study aims to scrutinize both the optimal timing and approach to inguinal hernia repair in neonates and preterm infants.

Methods: We conducted a literature review on surgical repair of IH in neonates and preterm infants published between 1999 and 2024.

Results: Twenty studies met the inclusion criteria for this review. All studies were retrospective, predominantly originating from Europe and the United States. Thirteen out of the 20 studies focused solely on preterm infants. Patient sample sizes ranged from 30 to 8037, totaling 14533 patients. Most studies indicate that delaying inguinal hernia repair in newborns and preterm infants does not increase the risk of incarceration or recurrence. Moreover, postponing repair until after discharge from the NICU correlates with a shorter postoperative hospital stay and notably diminishes the risk of long-term postoperative ventilator dependence, thereby mitigating potential perioperative complications. Hence, this approach seems safe for certain patients whose families can reliably access appropriate surgical care.

Conclusion: Significant disparities exist in the timing of inguinal hernia repair for newborns and preterm infants across various pediatric surgery centers. Current evidence suggests delayed inguinal hernia repair may be a viable option for selected patients. Regarding the optimal approach in this population, laparoscopy appears safe and effective.

Neonatal Riga-Fede disease: A systematic review of 84 cases collected over 120 years

AT Rangapriya, V Raveenthiran — Sun, 28 Jul 2024 00:00:00 -0400

Background: Traumatic ulceration of the tongue due to congenital teeth is known as Riga-Fede disease (RFD). The literature on RFD consists largely of anecdotal case reports, thereby lacking valid clinical recommendations. While managing a newborn with RFD complicated by Ludwig’s angina, this knowledge gap was recognized. Therefore, this systematic review was conducted to gain insight into the optimal management and the possible complications of RFD.

Methods: A literature search was conducted using PubMed, Google Scholar, and Science Direct, supplemented with African Journals Online, Indmed, and manual searches. Papers published between 1900 and July 2023 in any language were retrieved. Neonates with natal or neonatal teeth and ulceration of the oral mucosa were included. Papers with incomplete data and review articles were excluded.

Results: A total of 84 newborns with RFD from 62 published reports (including the case reported herein) were analyzed. Most of the reports were from the Indian subcontinent, and the frequency of reporting has increased since the year 2000. Tongue ulceration in all cases was due to mandibular incisors. There was no significant difference in the median duration of healing between the tooth extraction group (14 days) and the conservative management group (18 days). There was only a very weak positive correlation between the duration of symptoms and healing time, which was statistically insignificant.

Conclusion: Healing of mucosal ulcers in RFD is often protracted and does not appear to be influenced by the duration of symptoms or by the modality of treatment. Extraction of the offending teeth is more common (75% of cases) than conservative management, such as grinding (ameloplasty) or resin capping of teeth. RFD is mostly a benign disorder; however, serious complications such as meningitis, Ludwig’s angina, and soft tissue abscesses can rarely occur with Staphylococcus aureus infections.

Gastric perforation in neonates: Our experience

Sun, 31 Dec 2023 00:00:00 -0500

Background: Neonatal gastric perforation (NGP) is a life-threatening condition with a high mortality rate. It accounts for 7% of all gastrointestinal tract (GIT) perforations. The number of NGP cases has been increasing due to the rise in premature and low birth weight neonates. In this study, we present our experience with gastric perforation in neonates.

Methods: This retrospective study analyzed all cases of gastric perforation in neonates that were treated at Loma Linda University Medical Center's Neonatal Intensive Care Unit (NICU) between the years 2000 and 2023. The study looked at several variables including patient demographics, birth weight, age at admission and surgery, comorbidities, use of non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, and mortality rate.

Results: We treated 15 patients with neonatal gastric perforation (NGP) during the study tenure. The median age at admission was 2 days, with 67% admitted within that timeframe. Surgery occurred at a median age of 5.5 days, and the median birth weight was 2.075 kg, with 26.67% below 1 kg. Males comprised 67%, and 60% had patent ductus arteriosus. Steroids were given to 46.66%, and 30-day mortality was 26.67%, with higher rates among males. Idiopathic cases were common, with notable etiologies including ischemia, necrosis, and congenital anomalies. Primary surgical repair was the main modality, and perforations occurred at various locations. Two cases had necrotizing enterocolitis. Six patients had favorable outcomes, while others experienced mild to moderate complications.

Conclusion: Our research supports the idea that males have a worse outcome in terms of both prevalence and survival rates in neonatal gastric perforation (NGP) patients. However, our findings did not confirm the notion that NGP mortality risk is higher in neonates with low birth weight. We also discovered that the median time between admission and surgery in our study group was 1.5 days, emphasizing the importance of early detection of NGP in neonates. Early diagnosis can lead to better decision-making regarding treatment options and surgical intervention.

Somatostatin analog (octreotide) and sirolimus immunosuppressive therapy in the treatment of chyloperitoneum and chylothorax in newborns and infants

Wed, 03 Jan 2024 00:00:00 -0500

Background: Chyloperitoneum (CP) and chylothorax (CT) are rare conditions that have a high mortality rate and unclear treatment options. Their incidence in neonates ranges from 1 in 20000 to 1 in 187000 live births. This study aims to evaluate the effectiveness of synthetic somatostatin analog (octreotide) and sirolimus therapy in treating chylous pleural and peritoneal collections in newborns and infants.

Methods: We conducted a retrospective analysis of 10 children with either chylothorax or chyloperitoneum, treated in our department between 2018 and 2023. The study was approved by the Local Independent Ethics Committee of The National Medical Research Center of Children's Health, under Protocol №7, dated 11 May 2023. The parents voluntarily signed an informed consent form for the off-label use of the drug. We reviewed the medical records for demographic information, clinical presentation, management, and outcome.

Results: Our study looked at patients aged between 0 and 5.5 months, with seven cases of chyloperitoneum and three cases of chylothorax. We initially used octreotide, which was then switched to sirolimus if there was no improvement. Octreotide was effective in five children after 10-18 days of treatment, while the effect of sirolimus was observed 8-14 days after starting treatment. One patient, who had a history of a giant omphalocele with primary closure, experienced complications after 8 weeks of sirolimus therapy, including bilateral knee arthritis, leukopenia, and lymphopenia. Fortunately, there were no fatal outcomes.

Conclusion: Sirolimus therapy is effective in treating newborns with chylothorax or chyloperitoneum, with a low risk of complications even in those cases not responding to octreotide therapy. It is recommended that octreotide therapy should not exceed 10 days, after which sirolimus can be prescribed.

The outcomes of specific surgically correctable congenital gastro-intestinal malformations at a tertiary level neonatal intensive care unit in South Africa

Dr Ilhaam Abrahams, Prof Lizelle Van Wyk, Dr Corne De Vos — Sun, 31 Dec 2023 00:00:00 -0500

Background: The outcome of neonates with congenital surgically correctable gastro-intestinal (GIT) malformations is poorly described in low middle income countries.

Methods: A 5-year retrospective descriptive analysis of neonates admitted to a tertiary level neonatal intensive care unit (NICU), with congenital, surgically correctable GIT malformations, was performed. The primary outcome was the 30-day postoperative mortality as well as survival to 1 year. Secondary outcomes included patient demographics, clinical presentation as well as the burden of disease in our study population.

Results: Eighty-four neonates met study criteria. The mean gestational age was 35 weeks (SD 3.19) and birthweight 2518g (SD 789.3). The most common congenital malformations were intestinal atresia (39%) followed by omphaloceles (21%). Associated systemic malformations were common (39%). The majority of neonates (88%) underwent surgery at a median age of 2 days (IQR 1.5-5). Ventilation was required in 19% of neonates preoperatively and 65% postoperatively. Full feeds were achieved at a median age of 13 days (IQR 9-18) after surgery. The 30 day-postoperative survival rate was 97% with a survival to discharge or transfer of 86%. Data for one year survival was available for 80% of neonates with a one-year survival rate of 75%.

Conclusion: The 30-day postoperative survival was high in neonates with congenital, surgically correctable GIT malformations. Outcomes and burden on the healthcare system was dependent on the type of lesion. With early diagnosis and referral to a tertiary centre, good outcomes can be achieved. Neonates with congenital GIT malformations should have long term follow up to monitor growth and neurodevelopment as well as to address the high mortality post discharge.

Predictors of postoperative mortality among neonates after major-risk surgery: A one-year experience from a Tunisian hospital

Sun, 31 Dec 2023 00:00:00 -0500

Background: Neonatal surgery in developing countries remains a high-risk modality p and its outcomes depend on various patient-related, system-related, and management-related factors. This study aims to describe our experience in managing newborns requiring surgical interventions and to investigate the primary predictors of postoperative mortality.

Methods: In this observational study, we included all newborns aged less than 28 days who underwent surgery in the pediatric surgery department under general anesthesia with tracheal intubation for major-risk surgery. Patients were categorized into two groups based on the outcome (survival or death) during the two months following surgery. Following a comparison of the two groups, univariable and multivariable logistic regression analyses were conducted to explore predictors of perioperative mortality among neonates.

Results: Sixty-seven newborns were included in this study, with an early mortality incidence of 28.3%. Anesthesia management did not impact neonatal mortality. The main predictors of neonatal mortality were revision surgery [aOR=35.5; 95% CI: 1.33- 94.1], surgery duration ≥ 120 minutes [aOR=36.5; 95% CI: 1.48- 312], preoperative mechanical ventilation [aOR=3.88; 95% CI: 1.12- 30.8], and the occurrence of perioperative adverse events [aOR=5.7; 95% CI: 1–29.5] or postoperative surgical complications [aOR=32.5; 95% CI: 1.05–101].

Conclusion: The early mortality rate after major neonatal surgery remains high in our department. It appears that preoperative poor conditions can elevate the risk. Additionally, major-risk surgeries requiring prolonged procedures and revision surgery, along with the incidence of postoperative infections, significantly increase the risk of neonatal mortality.

Attrition rate among patients of Anorectal Malformations on colostomy: A matter of concern

Parveen Kumar, Sauradeep Dey, Ashvin Damdoo, Shishir Kumar, Vivek Manchanda — Mon, 06 May 2024 00:00:00 -0400

Background: Anorectal malformations (ARM) are correctable congenital malformations with good prognosis. Traditionally it is managed by staged procedure, with diversion colostomy, followed by definitive procedure and stoma reversal in the third stage. It is recommended to complete all stages of repair by 6 months of age for better long-term continence. We had fewer patients coming for definitive surgery and stoma reversal than the patients undergoing colostomy for ARM, so we planned this study to find out the attrition rate among patients undergoing stoma for ARM and explore the reasons for the same.

Methods: An observational study was conducted in the Pediatric Surgery department of Chacha Nehru Bal Chikitsalaya, New Delhi. All the case records of patients with ARM who underwent diversion stoma at our center from January 2018 to December 2019 were retrieved. Further follow-up case records were retrieved with the same Unique Health Identification Number (UHID). When the definitive surgery/ stoma closure was not found in the hospital records till December 2022, the parents were contacted telephonically to find out if the children had undergone definitive surgery at some other center, were awaiting surgery, or had died. The attrition was calculated as the difference between the number of patients for whom a stoma was done and the number of patients who underwent definitive surgery and stoma closure till the data acquisition.

Results: A total of 105 patients were included in the study with male preponderance. Colostomy was done for 73.33% of patients in the neonatal period (77/105). The cloacal malformation was found in 7 (6.67%), rectal atresia in 6 (5.71%), and 9 had congenital pouch colon (8.57%). The age at stoma creation for ARM ranged from 1 day to 9.3 years (mean 0.67 ±1.96 years). Cardiac and renal anomalies were among the major associations. 28 of the neonates (26.67%) had stomal complications. Stomal issues were reported in 32.4%. Mortality was reported in 37 patients (35.24%) including 35 neonates. The attrition rate in our study was found to be 38.24% (26 out of 68). Factors contributing to attrition range from anemia and protracted waiting lists to the anesthesiologist’s pursuit of optimal patient stabilization, alongside familial or personal matters faced by caregivers.

Conclusion: There was a high attrition rate in operated patients of ARM in whom stoma was constructed. The main reasons for the same were anemia and a long surgical waiting list.

Thoracoscopic primary repair of esophageal atresia and tracheoesophageal fistula: Our early experience

Tue, 25 Jun 2024 00:00:00 -0400

Background: Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) has been practiced more frequently in the past two decades. This study focuses on assessing our early experience with implementing this minimally invasive technique in neonates.

Methods: Neonates with EA/TEF who were admitted to the NICU at Ain Shams University hospitals during the period from 2021 to 2022 were enrolled in the study. Thoracoscopic primary repair was performed for neonates with a body weight exceeding 2 kg. Neonates with associated major cardiac, pulmonary, and neurological anomalies and long gap atresia were excluded from the study.

Results: A total of 38 neonates presented with EA/TEF during the study period. Out of these neonates, 12 cases underwent thoracoscopic primary repair. The thoracoscopic approach was used to complete all necessary repairs, and no intraoperative complications occurred. The mean operating time was 125 minutes, ranging from 105 to 150 minutes. No evidence of leakage was found in any case, as determined by both clinical and radiological contrast swallow examinations. The mean ventilation time was 7.2 days, and the mean hospital stay was 21 days. There were four deaths attributed to complications related to barotrauma and sepsis.

Conclusion: Thoracoscopic repair of EA can be performed safely, which yields favorable functional and cosmetic outcomes. However, it remains a challenging procedure that requires a long learning curve.

Characterization and outcomes of gastroschisis in two institutions of a middle-income country in Cali, Colombia, between 2018 and 2022

Wed, 11 Sep 2024 00:00:00 -0400

Background: Gastroschisis is the most common congenital defect of the abdominal wall. Its incidence has increased by 2 to 10 times worldwide. However, morbidity and mortality rates vary between high-, medium-, and low-income countries.

Methods: This is an observational, cross-sectional study aimed at establishing the prevalence of gastroschisis in babies admitted to the intensive care units of the Clinica Versalles and the Hospital Universitario del Valle (HUV). Additionally, it is analytical, as it seeks to identify the clinical and surgical factors associated with the mortality of these neonates. Data were collected based on the information already recorded in the clinical histories of patients born or referred to these institutions between January 2018 and June 2022.

Results: Fifty-six (56) babies were evaluated, with a birth rate corresponding to 1/1,000 live births. Of these, 35.70% were born to mothers under 19 years old, 55.36% came from municipalities other than Cali, and 91.07% were born at a gestational age greater than 32 weeks. Additionally, 58.90% were girls, with a median weight of 2,167 g (range: 1,440–3,240 g). Among the evaluated babies, 25% presented with complicated gastroschisis, and 44.64% had other malformations. The association between mortality outcomes and clinical factors showed that invasive mechanical ventilation for longer than 7 days increased the probability of death by 7.94 times, sepsis by 8.35 times, pulmonary hypertension by 7.14 times, acute kidney injury by 8.87 times, and pneumonia by 7.14 times. The surgical factors significantly associated with mortality were abdominal compartment syndrome (13.67 times), staged closure (9.17 times), more than two surgical interventions (7.80 times), failure to achieve closure (30.71 times), post-surgical complications (5.29 times), and intestinal ischemia (43 times).

Conclusion: The rate of gastroschisis in this study is notably higher than that reported in other countries, with a substantial number of clinical and surgical complications significantly associated with mortality. Key factors influencing mortality include prolonged invasive mechanical ventilation, sepsis, pulmonary hypertension, acute kidney injury, and pneumonia. Surgical factors such as abdominal compartment syndrome, staged closure, multiple surgical interventions, failure to achieve closure, post-surgical complications, and intestinal ischemia also greatly increase the risk of death.

Unveiling the fungal frontier: Exploring pediatric surgical cases with bowel mucormycosis through a retrospective lens

Parveen Kumar, Vivek Manchanda, Chhabi Ranu Gupta, Arti Khatri — Thu, 28 Nov 2024 00:00:00 -0500

Background: Bowel mucormycosis is common among high-risk surgical neonates and has high fatality. This study was done to study the clinical profile and outcome of pediatric surgical patients operated at our center who had bowel mucormycosis on histology.

Methods: It was a retrospective observational study. The data was collected from the medical records department. The files of surgical patients with tissue diagnosis of bowel mucormycosis operated at Chacha Nehru Bal Chikitsalaya from June 2018 to May 2021 were retrieved. The data was tabulated on Microsoft Excel sheet®.

Results: A total of 11 surgical patients with bowel mucormycosis on histology were traced. The study had male preponderance. The majority were neonates and had low platelet counts with raised CRP levels. All but one expired, with severe sepsis and septic shock as major causes of death.

Conclusion: The invasive mucormycosis is more common among neonates (but older children are not immune) with male preponderance. It may affect any part of GIT and the counts and sepsis screen may be normal. It has a high fatality rate.

Second-look surgery in a patient of malrotation with midgut volvulus

Survesh Kumar Gupta, Anand Pandey, Rahul Kumar Rai, Nirpex Tyagi — Wed, 03 Jan 2024 00:00:00 -0500

A case of anorectal malformation with human tail

Omar Ajaj — Sun, 31 Dec 2023 00:00:00 -0500

Neutrophil to Lymphocyte ratio: A promising tool in neonatal appendicitis diagnosis

Emine Burcu Cigsar Kuzu — Sun, 31 Dec 2023 00:00:00 -0500

Staged repair of esophageal atresia, tracheoesophageal fistula, and duodenal atresia in a newborn

Sun, 14 Jan 2024 00:00:00 -0500

Caudal regression syndrome in a newborn in distress: A therapeutic challenge

Mon, 26 Feb 2024 00:00:00 -0500

Palatal teratoma in a 1-day-old full-term female neonate

Tue, 28 May 2024 00:00:00 -0400

Are subclavian percutaneous central venous catheters an alternative to Hickman-Broviac catheters in neonates and young infants?

Anouar Jarraya, Manel Kammoun, Olfa Cherif, Mariem Ben Abdallah — Sat, 20 Jul 2024 00:00:00 -0400

A case involving penile necrosis after circumcision

Muhammad Zaeem Khalid, Muhammad Ali Sheikh, Ameena Azeemi, Maria Iftikhar Raja — Wed, 14 Aug 2024 00:00:00 -0400