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Gastroschisis In gastroschisis, an abdominal wall defect lies to the right- hand side of the umbilical cord and transmits the small and large intestine, stomach, bladder and sometimes the ovaries or undescended abdominal testes ( Figure 18.16 ). Risk factors i...

Hirschsprung’s disease Genetic defects (e.g. RET , EDNRB, EDN3 ) can a ff ect the - migration of neural crest-derived intestinal neurones (neuro - ), cristopathy), leading to aganglionosis and thickened nerve trunks in the distal bowel. There may be a family h...

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, ane...

Learning objectives To be able to: List /f_i ve aetiological classes underlying structural • congenital anomalies Give /f_i ve examples of how neonatal physiology and • anatomy in /f_l uence surgical care Describe at least /f_i ve congenital anomalies managed ...

Malrotation and volvulus Complex rotations in utero give the small bowel mesentery its broad, stable base, running from the duodenal–jejunal (DJ) flexure in the left upper quadrant to the caecum in the right lower quadrant. Incomplete rotations leave the mesent...

Meconium ileus Inspissated meconium may cause a distal ileal obstruction. A segmental ileal volvulus can follow and create an atresia. If the ileum perforates, it may seal or persist and cause a large meconium pseudocyst. An abdominal radiograph shows obstruct...

NEONATAL GASTROINTESTINAL SURGERY Oesophageal atresia/ tracheoesophageal fi stula (OA/TOF) Five anatomical variations appear in Figure 18.1 . When the oesophagus ends blindly , amniotic fl uid cannot be swallowed - and polyhydramnios results. If there is no ...

NEONATAL GASTROINTESTINAL SURGERY Oesophageal atresia/ tracheoesophageal fi stula (OA/TOF) Five anatomical variations appear in Figure 18.1 . When the oesophagus ends blindly , amniotic fl uid cannot be swallowed - and polyhydramnios results. If there is no ...

NEWBORN PHYSIOLOGY AND THE PRINCIPLES OF NEONATAL SURGERY Neonatal physiology can pose challenges when there is a surgi - cal condition ( Table 18.2 ) . Perioperatively , a newborn needing - ventilation is best managed in a surgical unit co-located with a medi...

NEWBORN PHYSIOLOGY AND THE PRINCIPLES OF NEONATAL SURGERY Neonatal physiology can pose challenges when there is a surgi - cal condition ( Table 18.2 ) . Perioperatively , a newborn needing - ventilation is best managed in a surgical unit co-located with a medi...

NEWBORN PHYSIOLOGY AND THE PRINCIPLES OF NEONATAL SURGERY Neonatal physiology can pose challenges when there is a surgi - cal condition ( Table 18.2 ) . Perioperatively , a newborn needing - ventilation is best managed in a surgical unit co-located with a medi...

Necrotising enterocolitis NEC is a patchy haemorrhagic enteritis seen in about 10% of preterm babies on NICUs; all are more than a few days old and have been fed. NEC is less common in breastfed than in formula-fed babies. NEC commonly involves the colon and t...

Pulmonary airway malformations There are three groups: congenital cystic adenomatoid malfor - mations (CCAMs), bronchopulmonary sequestrations (BPSs) - and congenital lobar emphysema (CLE). The sequestrations may be intralobar or extralobar and are accompanied...

Sacrococcygeal teratoma These germ cell tumours arise from the coccyx and are usually diagnosed antenatally . They may have internal and external components or both ( Figure 18.20 ). Most are benign mature teratomas, but some contain immature embryonic element...

Small bowel atresias Small bowel atresias may be isolated ( Figure 18.5 ) or multiple. If seen without other anomalies, they are thought to have been caused by localised vascular events occurring after organogene sis. Rarely multiple intestinal atresias are se...

THORACIC SURGERY Congenital diaphragmatic hernia Several genes share roles in diaphragmatic, pulmonary , cardiac and foregut development; consequently , congenital diaphrag matic hernias are associated with lung hypoplasia, pulmonary hypertension, cardiac defe...

WHY ADUL T SURGEONS NEED AN OVERVIEW OF NEONATAL SURGERY Rarely , malrotation, congenital diaphragmatic hernias and lung malformations described in this chapter may present for the first time in adulthood. More commonly , adults who had neonatal surgery may pre...

WHY ADUL T SURGEONS NEED AN OVERVIEW OF NEONATAL SURGERY Rarely , malrotation, congenital diaphragmatic hernias and lung malformations described in this chapter may present for the first time in adulthood. More commonly , adults who had neonatal surgery may pre...