Introduction

INTRODUCTION

Neonatal surgeons are paediatric surgeons who manage life-threatening non-cardiac congenital anomalies and the acquired condition necrotising enterocolitis (NEC), seen in premature babies. Structural anomalies are associated with gene defects, aneuploidies (abnormal number of chromo somes), infections (e.g. toxoplasmosis, cytomegalovirus, rubella) and teratogens (e.g. drugs, smoking, alcohol). Late mechanical aetiologies are illustrated by ileal volvulus in cystic fibrosis, some lung hypoplasia in congenital diaphragmatic hernias and small intestine loss in closing g astroschisis. Insults acting during gastrulation /uni00A0 – /uni00A0 when cells are told what to do and where to go /uni00A0 – /uni00A0 may cause multiple anomalies, e.g. V ACTERL syndrome ( v ertebral, a norectal, c ardiac, t racheo e sophageal, r enal and l imb anomalies) and CHARGE syndrome ( c oloboma, defects, choanal a tresia, growth r etardation, g enital anomalies and e ar anomalies). See Chapter 44 for neural tube defects and Chapter 59 for heart defects. See Chapter 48 for the over lap with general surgery of childhood. Table 18.1 illustrates the need for careful examination, imaging and genetic inves tigations to screen for associations when an anomaly is found. When well-recognised anomalies ar e identified antenatally , neonatal surgeons, working with fetal medicine specialists and neonatologists, counsel parents about prognosis and postnatal surgical management. Friedrich Trendelenburg , 1844–1924, Professor of Surgery successively at Rostock (1875–1882), Bonn (1882–1895), Leipzig (1895–1911), Germany . The Tren delenburg position was first described in 1885.

Outline the presentation and management of necrotising • enterocolitis Describe two newborn tumours • Explain why adult surgeons need an overview of neonatal • surgery