Journal of Neonatal Surgery https://www.jneonatalsurg.com/ojs/index.php/jns <p class="style58" style="text-align: justify; line-height: 16.5pt; background: white; margin: 12.0pt 0in 12.0pt 0in;"><span style="font-size: 11.5pt; font-family: 'Arial',sans-serif; color: black;"><strong>Journal of Neonatal Surgery (ISSN: 2226-0439)</strong> is a peer-reviewed, open-access, electronic journal promoting the dispersion of quality research in Neonatal Surgery. It is the only journal dedicated to Neonatal Surgery- a developing specialty. The journal also provides an opportunity for learning "Medical Writing" for young pediatric and neonatal surgeons. Our editorial team works hard to guide new writers in this field. The journal publishes quality research that will improve outcomes of neonatal surgery, especially in resource-constrained settings. Our main aim is to reduce morbidity and mortality of neonatal surgery by publishing the latest trends in this discipline, in a special context to developing countries. We invite pediatric and neonatal surgeons for their quality contributions to the Journal of Neonatal Surgery and for helping us achieve these goals.</span></p> El-Med-Pub en-US Journal of Neonatal Surgery 2226-0439 <h3>You are free to:</h3> <ul class="license-properties"> <li class="license share"><strong>Share</strong> — copy and redistribute the material in any medium or format</li> <li class="license remix"><strong>Adapt</strong> — remix, transform, and build upon the material for any purpose, even commercially.</li> </ul> <p><strong>Terms:</strong></p> <ul> <li><strong>Attribution</strong> — You must give <a id="appropriate_credit_popup" class="helpLink" tabindex="0" title="" href="https://creativecommons.org/licenses/by/4.0/" data-original-title="">appropriate credit</a>, provide a link to the license, and <a id="indicate_changes_popup" class="helpLink" tabindex="0" title="" href="https://creativecommons.org/licenses/by/4.0/" data-original-title="">indicate if changes were made</a>. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.</li> <li><span id="by-more-container"></span><strong>No additional restrictions</strong> — You may not apply legal terms or <a id="technological_measures_popup" class="helpLink" tabindex="0" title="" href="https://creativecommons.org/licenses/by/4.0/" data-original-title="">technological measures</a> that legally restrict others from doing anything the license permits.</li> </ul> Gastric perforation in neonates: Our experience https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1242 <p>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.</p> <p>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.</p> <p>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.</p> <p style="font-weight: 400;">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.</p> Fransua Sharafeddin Brandon Edelbach Alexandra Vacaru Georgi Mladenov Donald Moores Yogen Singh Andrei Radulescu Copyright (c) 2023 Fransua Sharafeddin, Brandon Edelbach, Alexandra Vacaru, Georgi Mladenov, Donald Moores, Yogen Singh, Andrei Radulescu https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2 10.47338/jns.v13.1242 Somatostatin analog (octreotide) and sirolimus immunosuppressive therapy in the treatment of chyloperitoneum and chylothorax in newborns and infants https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1240 <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> A Gurskaya M Sulavko E Ekimovskaya R Bayazitov O Nakovkin I Karnuta A Klepikova D Akhmedova R Hagurov G Sagoyan Copyright (c) 2023 Aleksandra Gurskaya, Mariya Sulavko, Ekaterina Ekimovskaya, Rimir Bayazitov, Oleg Nakovkin, Inna Karnuta, Anna Klepikova, Dinara Akhmedova, Ruslan Hagurov, Garik Sagoyan, Yelena Dyakonova, Andrey Fisenko https://creativecommons.org/licenses/by/4.0 2024-01-03 2024-01-03 13 3 3 10.47338/jns.v13.1240 The outcomes of specific surgically correctable congenital gastro-intestinal malformations at a tertiary level neonatal intensive care unit in South Africa https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1250 <p>Background: The outcome of neonates with congenital surgically correctable gastro-intestinal (GIT) malformations is poorly described in low middle income countries.</p> <p>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.</p> <p>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%.</p> <p>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.</p> Ilhaam Abrahams Lizelle Van Wyk Corne De Vos Copyright (c) 2023 Dr Ilhaam Abrahams, Prof Lizelle Van Wyk, Dr Corne De Vos https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 8 8 10.47338/jns.v13.1250 Predictors of postoperative mortality among neonates after major-risk surgery: A one-year experience from a Tunisian hospital https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1275 <p>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.</p> <p>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.</p> <p>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].</p> <p>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.</p> Manel Kammoun Anouar jarraya Hechem bradai Hind ketata Hasna Bouchaira Olfa Cherif Amel Ben Hamed Faiza Safi Riadh Mhiri Copyright (c) 2023 Manel Kammoun, Anouar jarraya, Hechem bradai, Hind ketata, Hasna Bouchaira, Olfa Cherif, Amel Ben Hamed, Faiza Safi, Riadh Mhiri https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 10 10 10.47338/jns.v13.1275 Second-look surgery in a patient of malrotation with midgut volvulus https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1258 Survesh Kumar Gupta Anand Pandey Rahul Kumar Rai Nirpex Tyagi Copyright (c) 2023 Survesh Kumar Gupta, Anand Pandey, Rahul Kumar Rai, Nirpex Tyagi https://creativecommons.org/licenses/by/4.0 2024-01-03 2024-01-03 13 5 5 10.47338/jns.v13.1258 A case of anorectal malformation with human tail https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1270 Omar Ajaj Copyright (c) 2023 Omar Ajaj https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 6 6 10.47338/jns.v13.1270 Neutrophil to Lymphocyte ratio: A promising tool in neonatal appendicitis diagnosis https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1247 Emine Burcu Cigsar Kuzu Copyright (c) 2023 Emine Burcu Cigsar Kuzu https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 7 7 10.47338/jns.v13.1247 Staged repair of esophageal atresia, tracheoesophageal fistula, and duodenal atresia in a newborn https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1261 Christos Tsakalidis Maria Lithoxopoulou Nikolaos Gkiourtzis Eftychia Drogouti Vassilios Mouravas Ioannis Spyridakis Elisavet Diamanti Copyright (c) 2023 Christos Tsakalidis, Maria Lithoxopoulou, Nikolaos Gkiourtzis, Eftychia Drogouti, Vassilios Mouravas, Ioannis Spyridakis, Elisavet Diamanti https://creativecommons.org/licenses/by/4.0 2024-01-14 2024-01-14 13 11 11 10.47338/jns.v13.1261 Amyand hernia with perforated appendix simulating as testicular torsion in a neonate: A case report https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1252 <p>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.</p> <p>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.</p> <p>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.</p> Obay Edan Copyright (c) 2023 Obay Edan https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 9 9 10.47338/jns.v13.1252 Perioperative fluid and electrolyte management in surgical neonates https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1225 <p>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.</p> Nitin James Peters Shivani Dogra Sandhya Yaddanapudi Jai Kumar Mahajan Copyright (c) 2023 Nitin James Peters, Shivani Dogra, Sandhya Yaddanapudi, Jai Kumar Mahajan https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 4 4 10.47338/jns.v13.1225 Artificial intelligence and writing: What ChatGPT says? https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1280 Muhammad Bilal Mirza Copyright (c) 2023 Muhammad Bilal Mirza https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 1 1 10.47338/jns.v13.1280