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Surgical Conditions of the Newborn

Editorial

Kokila Lakhoo

PhD, FRCS(ENG+EDIN),FCS(SA), MRCPCH(UK), MBBCH

Consultant Paediatric Surgeon and Honorary Senior Lecturer

Department of Paediatric Surgery

Children’s Hospital Oxford

Oxford University Hospitals and University of Oxford, Oxford, UK


It has been a great pleasure in guest editing for this special issue of the Journal of Paediatric Surgical Specialities. ‘Surgical Conditions of the Newborn’ seems an appropriate topic as it highlights the challenges with surgical newborns and their outcomes which are mainly resource dependent. This issue concentrates on index cases and written in a style between a journal and a text book. It is aimed at providing basic knowledge and expanding to challenges related to the condition. Congenital Diaphragmatic Hernia has a huge medical input but the author has emphasised the importance of joint care with surgical input and the various techniques of repair depending on the resource available.

Management of Oesophageal Atresia and Trachea-Oesophageal Fistula has been standardised but isolated oesophageal atresia still poses challenges to the attending surgeon. Outcomes are dictated by the comorbidity of associated abnormalities and extreme prematurity with low birth weights and immature lungs.

Pathology of congenital lung lesions has been revised recently and brought prenatally diagnosed selected conditions under the umbrella of Congenital Pulmonary Airway Malformation (CPAM). The management of these prenatally diagnosed lung lesions which are asymptomatic in the postnatal period still remains a debate in current practice. The authors present both sides of the argument and describe the various surgical techniques.

Abdominal wall defects described in this issue mainly encompass exomphalos and gastroschisis. The morbidity and mortality for exomphalos is usually related to the presence of associated abnormalities whereas with gastroschisis it lies with the complexity of the disease. Mainly a positive and good outcome but in the small percentage of challenging complex gastroschisis, the mobidity tend to be crippling to the patient and their families.

Bowel Obstruction in the newborn is well described by the authors and described the challenges with the type IIIb variety. They have further highlighted the importance of a timely diagnosis of the ‘malrotation with volvulus’ component of their manuscript. Knowledge of the malrotation with volvulus with expedited treatment is well emphasised.

Despite extensive research and many clinical trials the outcome for necrotising enterocolitis has not improved. Present management and predictions for this conditions are outlined with the hope to increase awareness of this vulnerable group of extreme premature babies who are inflicted with this disease. Surgical procedures tailored to the intraoperative finding are further described.

The 2 main neonatal distal bowel conditions, namely, Hirschprung’s Disease and Anorectal malformations are outlined as separate topics but within a single manuscript. The variation in both the conditions are described and the long-term outcomes and challenges with bowel washout programmes touched upon.

Neonatal conditions cannot be completed without the inclusion of urological obstructive conditions. The spectrum of conditions are described and the challenging condition of posterior urethral valves from prenatal diagnosis to long-term follow-up are well outlined. The last 2 articles are challenging case reports shared with the journal readership.

It is my sincere hope that this issue will provide the knowledge and support to colleagues and trainees in the care of the surgical newborn.