Journal of Neonatal Surgery <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="" data-original-title="">appropriate credit</a>, provide a link to the license, and <a id="indicate_changes_popup" class="helpLink" tabindex="0" title="" href="" 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="" data-original-title="">technological measures</a> that legally restrict others from doing anything the license permits.</li> </ul> Short Bowel Syndrome in neonates and early infancy <p>Short bowel syndrome (SBS) is the commonest cause of intestinal failure in neonates. SBS results from widespread damage to the small intestine, leading to loss of functional capacity of this organ. This is generally secondary to conditions like necrotizing enterocolitis, gastroschisis, intestinal atresia, and midgut volvulus. The small bowel usually adapts to this damage in due course of time. The clinician's role usually entails the management of parenteral nutrition and the fluid and electrolyte balance to tide over this phase. The management should be initiated as soon as the diagnosis is suspected, especially post-surgical resection of the bowel. This should comprise enteral nutrition, with proactive monitoring and supplementation of electrolytes and micronutrients. Intestinal lengthening procedures like the Serial transverse enteroplasty (STEP), and Longitudinal intestinal lengthening and tailoring (LILT) may be considered in infants, where medical therapy fails to correct the pathology. The intricate nature of the condition warrants a multi-disciplinary approach, involving clinicians, intensivists, and surgeons, which ensures the best neonatal outcomes, in terms of the survival rates in these babies.</p> Shivani Dogra Nitin James Peters Ram Samujh Copyright (c) 2023 Shivani Dogra, Nitin James Peters, Ram Samujh 2023-01-14 2023-01-14 12 8 8 10.47338/jns.v12.1148 Spontaneous perforation of Meckel's diverticulum causing a partial small bowel obstruction: A case report <p>Background: Meckel's diverticulum is a common congenital malformation in young children. Perforation of Meckel's diverticulum in a neonate is a rarity and poses diagnostic and management challenges.</p> <p>Case Presentation: This patient is a former 26 5/7 week estimated gestational age infant who presented at 41 weeks corrected gestational age with abdominal distension and was discovered to have a perforated Meckel's diverticulum that presented as a partial small bowel obstruction. Resection of the involved bowel and ileo-ileal anastomosis was performed.</p> <p>Conclusion: Small bowel obstructions should be considered as a potential presentation of a perforated Meckel's diverticulum.</p> Simran Koura Veronica Urbik Richard Overman Rohini Olson Maja Herco Shannon Longshore Copyright (c) 2023 Simran Koura, Veronica Urbik, Richard Overman, Rohini Olson, Maja Herco, Shannon Longshore 2023-01-09 2023-01-09 12 7 7 10.47338/jns.v12.1127 Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report <p>Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery.</p> <p>Case Presentation: A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment cesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apneic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high-frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day 10, gradual removal of five chest drains by day 19, and extubation on day 24. Transillumination and chest radiography were the main diagnostic investigations. Laryngotracheobronchoscopy on day 16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis, and pulmonary hypertension and was discharged home on day 66.</p> <p>Conclusion: Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Management is patient-specific and includes needle and tube thoracocentesis and often, mechanical ventilation. Our case demonstrates the challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum.</p> Heerani Woodun Jeremy Thomas Dushyant Batra Nia Fraser Copyright (c) 2023 Heerani Woodun, Jeremy Thomas, Dushyant Batra, Nia Fraser 2023-01-10 2023-01-10 12 9 9 10.47338/jns.v12.1165 Two-stage surgical management of horseshoe lung associated with congenital pulmonary airway malformation in a neonate: A case report <p>Background: Horseshoe lung is a rare congenital malformation, and even rarer is its association with congenital pulmonary airway malformations.</p> <p>Case Presentation: We report a case of horseshoe lung associated with congenital pulmonary airway malformation (Stocker type 2) who underwent surgical management in two stages. The patient had a right posterolateral thoracotomy with lower right lobectomy at 14 days of life, followed by a left posterolateral thoracotomy with lower left lobectomy at 7 months of age. He is doing fine after both surgeries and follow-up visits are ongoing.</p> <p>Conclusion: The treatment of horseshoe lung should be individualized, surgical management is an effective option and the two-stage approach in neonates would reduce the risk of the simultaneous bilateral procedure.</p> Veronica Polit-Guerrero Jimmy Andrade-Montesdeoca Ernesto Fabre-Parrales Vicente Salinas-Salinas Daniel Acosta-Farina Copyright (c) 2023 Veronica Polit-Guerrero, Jimmy Andrade-Montesdeoca, Ernesto Fabre-Parrales, Vicente Salinas-Salinas, Daniel Acosta-Farina 2023-04-21 2023-04-21 12 14 14 10.47338/jns.v12.1215 Choledochal cyst presenting with neonatal intestinal obstruction: A case report <p>Background: Most patients with choledochal cysts are diagnosed during childhood. Therefore, the aim of this study is to report a case of early detected choledochal cyst in a neonate patient presenting with intestinal obstruction. <strong> </strong></p> <p>Case Presentation: A 5-day-old baby girl was brought to the hospital with a chief complaint of bilious vomiting. No history of jaundice was found. Ultrasound in the third trimester (37 weeks) showed an anechoic cyst with a smooth wall, no septum, with a size of 5.5x4.7x4.7 cm, suspected ovarian cyst. At 4 days old, MRCP showed dilated right and left Intrahepatic bile duct with a normal gallbladder, suspected as choledochal cyst Todani type 1. The patient was operated on at 7 days old and was discharged 15 days after surgery. Nine months after discharge, the patient was in good condition with no complaints of jaundice nor acholic stool and normal liver function test.</p> <p>Conclusion: Prenatal diagnosis of choledochal cyst gave awareness to receive appropriate treatment. Bowel obstruction without jaundice could be an early symptom of a choledochal cyst in neonates.</p> IGB Adria Hariastawa Yoshua Eric Irawan Illona Okvita Wiyogo Copyright (c) 2023 IGB Adria Hariastawa, Yoshua Eric Irawan, Illona Okvita Wiyogo 2023-07-09 2023-07-09 12 19 19 10.47338/jns.v12.1202 Giant segmental dilatation of jejunum causing volvulus in an infant: A case report <p>Background: Giant segmental dilatation of jejunum (SDJ) is rare in small infants where it often presents with intestinal obstruction. Occasionally, the giant SDJ may twist resulting in volvulus.</p> <p>Case Presentation: A 1-month-old female infant presented with intestinal obstruction. At surgery, isolated giant segmental dilatation of the jejunum causing volvulus of the bowel was found. The gut was viable. The SDJ was excised and jejuno-jejunal anastomosis was performed. Ladd’s procedure was also performed for the associated malrotation. Postoperative recovery remained uneventful.</p> <p>Conclusion: Giant SDJ is a rare entity, rarer still is its presentation with volvulus secondary to its twist. Early diagnosis and prompt management result in a good outcome.</p> Abdullah Khan Assad Ameer Allah Ditta Laraib Amjad Kashif Nawaz Samina Zaman Nabila Talat Copyright (c) 2023 Abdullah Khan, Assad Ameer, Allah Ditta, Laraib Amjad, Kashif Nawaz, Samina Zaman, Nabila Talat 2023-07-21 2023-07-21 12 21 21 10.47338/jns.v12.1227 Gastric pneumatosis in a preterm infant: A case report <p>Background: Gastric pneumatosis is a rare condition characterized by the presence of intramural gas in the stomach wall. It is uncommon in infants and is usually caused by proximal intestinal obstruction or necrotizing enterocolitis, a serious condition typically seen in preterm babies.</p> <p>Case Presentation: An extremely preterm baby born at 23 weeks of gestation weighing 640 grams, with bronchopulmonary dysplasia and other comorbidities like patent ductus arteriosus, staph aureus sepsis, developed abdominal distension and non-bilious vomiting at 4 months of age. X-ray abdomen revealed gastric pneumatosis. The condition was managed with conservative measures.</p> <p>Conclusion: Gastric pneumatosis secondary to necrotizing enterocolitis is uncommon in infants and needs prompt evaluation and management to prevent further deterioration.</p> Paramesh Sreekumar Prince Raj Arjun Chandra Dey Emad Shatla Martin Thomas Corbally Copyright (c) 2023 Paramesh Sreekumar, Prince Raj, Arjun Chandra Dey, Emad Shatla, Martin Thomas Corbally 2023-08-28 2023-08-28 12 24 24 10.47338/jns.v12.1209 Duodenal atresia, annular pancreas, and situs inversus totalis- rare association in a newborn: A case report <p>Background: Simultaneous occurrence of duodenal atresia, annular pancreas, and situs inversus totalis is an exceedingly rare clinical condition. This may pose management-related challenges to the treating surgeon.</p> <p>Case Presentation: We report a case with a preoperative diagnosis of duodenal atresia and situs inversus. Intraoperatively, an annular pancreas encircling the duodenum was found. Instead of duodenoduodenostomy, a duodenojejunal anastomosis was performed. The postoperative course remained uneventful. The patient is doing fine on a 6-month follow-up.</p> <p style="font-weight: 400;">Conclusion: The simultaneous presence of multiple anomalies in this patient prompted us to utilize an alternative approach to relieve the duodenal obstruction. This report highlights the importance of tailoring surgical decisions based on the individualized needs of the patient.</p> M V LS Boris Gogan Koto Toualouth Lafia Codjo Serge Metchihoungbe CA Médard Amoussou MGI Sergine Dossou Michel Armand Fiogbe Copyright (c) 2023 M V LS Boris Gogan, Koto Toualouth Lafia, Codjo Serge Metchihoungbe, CA Médard Amoussou, MGI Sergine Dossou, Michel Armand Fiogbe 2023-09-05 2023-09-05 12 26 26 10.47338/jns.v12.1218 Triple atresia: Staged repair Meryem Unal Muhammad Fadli Abdullah Hazlina Mohd Khalid Mughni Bahari Copyright (c) 2023 Meryem Unal, Muhammad Fadli Abdullah, Hazlina Mohd Khalid, Mughni Bahari 2023-01-03 2023-01-03 12 5 5 10.47338/jns.v12.1105 Poor outcomes in congenital short bowel syndrome with intestinal malrotation: Experience from a developing country Rachida Lamiri Ghada Habachi Nahla Hmidi Nahla Kechiche Mabrouk Abdelaali Seifeddine Zayani Amine Ksia Lassaad Sahnoun Mongi Mekki Mohsen Belghith Copyright (c) 2023 Rachida Lamiri, Ghada Habachi, Nahla Hmidi, Nahla Kechiche, Mabrouk Abdelaali, Seifeddine Zayani, Amine Ksia, Lassaad Sahnoun, Mongi Mekki, Mohsen Belghith 2023-04-04 2023-04-04 12 12 12 10.47338/jns.v12.1182 Re: Constrained evidence-based practice Amit Trivedi Nadia Badawi Gordon Thomas Copyright (c) 2023 Amit Trivedi, Nadia Badawi, Gordon Thomas 2023-04-25 2023-04-25 12 15 15 10.47338/jns.v12.1208 Rapidly growing ranula and its management in a neonate Anouar Jarraya Manel Kammoun Chiraz Regaieg Khadija Ben Ayed Abdennaceur Bouattour Souha Kallel Fathi Karray Amel Ben Hamed Nedia Ben Hamida Copyright (c) 2023 Anouar Jarraya, Manel Kammoun, Chiraz Regaieg, Khadija Ben Ayed, Abdennaceur Bouattour, Souha Kallel, Fathi Karray, Amel Ben Hamed, Nedia Ben Hamida 2023-08-15 2023-08-15 12 23 23 10.47338/jns.v12.1205 Intrauterine toes gangrene in a neonate Fariba Hemmati Hamide Barzegar Copyright (c) 2023 Fariba Hemmati, Hamide Barzegar 2023-05-14 2023-05-14 12 16 16 10.47338/jns.v12.1186 Nucleated red blood cells as a potential biomarker for predicting spontaneous intestinal perforation in premature infants <p>Background: The specific etiology of spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) remains elusive. Both can present acutely without antecedent signs and can be difficult to differentiate. Neonatal nucleated red blood cell (NRBC) counts are part of the routine admission and serial CBCs drawn on premature neonates. Elevated NRBC counts could represent relative intrauterine hypoxemia, a possible risk factor for the development of SIP or NEC.</p> <p>Methods: We compared premature neonates with SIP to premature neonates with NEC and controls, matched gestational age (GA) and birth weight (BW). Kruskal-Wallis, Chi-Square, or Fisher's exact tests and univariate and multivariate nominal logistic regression models were used to estimate the association of baseline NRBC. Median times to SIP and NEC were calculated using the Kaplan-Meier method. All analyses were performed with SAS 9.4.</p> <p>Results: Male sex (72.5%), lower GA [Median (Q1, Q3): 25.1 (23.8, 28)], and lower BW [Median (Q1, Q3): 690 g (585, 1072)] had the highest incidence of SIP compared to NEC or controls. Increased baseline NRBC was associated with lower odds of developing NEC compared to controls [Median (Q1, Q3): 9 (5, 29) vs 19 (10, 51); OR (CI) 0.70 (0.55, 0.89), p-value = 0.0033]. Increased baseline NRBC was associated with higher odds of developing SIP compared to NEC [Median (Q1, Q3): 9 (5, 29) vs 19 (10, 51); OR (CI) 1.61 (1.18, 2.20) p-value = 0.0027]. There were no significant differences between intrauterine growth restriction (IUGR), maternal hypertension, chorioamnionitis, multiple births, or depressed APGAR scores in all three groups. NRBC for SIP neonates remained significantly higher at the day of life (DOL) 1-3 compared to other groups [Median (Q1, Q3): 23 (6, 93), p-value = 0.0020]. The percentage of patients with NRBC &gt;4, remained elevated for patients with SIP as late as week three (p = 0.0023).</p> <p>Conclusion: ELBW, male sex, and elevated baseline NRBC were significantly associated with the risk of developing SIP compared to NEC or controls. NRBC remained significantly elevated on DOL 1-3, compared to NEC or controls. Between the groups, there were no significant differences in perinatal stressors.</p> Michaela O'Neill Roia Katebian Mollie Shutter Amy Wozniak Phillip J. DeChristopher Loretto Glynn Marc G. Weiss Jonathan K. Muraskas Copyright (c) 2023 Michaela O'Neill, Roia Katebian, Mollie Shutter, Amy Wozniak, Phillip J. DeChristopher, Loretto Glynn, Marc G. Weiss, Jonathan K. Muraskas 2023-01-31 2023-01-31 12 2 2 10.47338/jns.v12.1159 Factors associated with cholestasis after surgery for congenital duodenal atresia <p>Background: This study assessed the characteristics of neonates with duodenal atresia (DA) who developed transient postoperative cholestasis which resolved spontaneously, without identifiable congenital anomalies or surgical complications, and identified potential risk factors for cholestasis.</p> <p>Methods: Neonates with DA who underwent surgery at our institution between January 2009 and July 2022 were retrospectively reviewed. Demographic factors, intraoperative findings, placement of a trans-anastomotic tube (TAT), and postoperative outcomes were compared between patients who developed cholestasis (conjugated hyperbilirubinemia &gt;2.0 mg/dL) after surgery (Group A) and those who did not (Group B). This report is a retrospective cohort study and complies with the STROBE statement.</p> <p>Results: Among 19 neonates with DA, 6 (31.6%) developed cholestasis after surgery, with the highest direct bilirubin value being 4.3 (2.4-6.5) mg/dL (median, [range]) on postoperative day 14.5 (2-23) that persisted for 67 (47-116) days until spontaneous resolution. Neonates in Group A had a significantly younger gestational age (36.6 vs. 38.0 weeks) (median) (p=0.038), a higher rate of Down syndrome (66.7 vs. 15.4%) (p=0.046), a higher rate of TAT placement (66.7 vs. 15.4%) (p=0.046), and longer administration of total parenteral nutrition (15.5 vs. 7.0 days) (p=0.027) than those in Group B.</p> <p>Conclusion: Transient cholestasis after surgery for DA seemed to be associated with prematurity, Down syndrome, parenteral nutrition, and TAT placement.</p> Yosuke Minami Kazuaki Takiguchi Hirofumi Shimizu Hideaki Tanaka Copyright (c) 2023 Yosuke Minami, Takiguchi Kazuaki, Hirofumi Shimizu, Hideaki Tanaka 2023-03-23 2023-03-23 12 11 11 10.47338/jns.v12.1158 Epidemiology of congenital diaphragmatic hernia, esophageal atresia, and gastroschisis in South Brazil <p>Background: Birth defects remain a major contributor to infant mortality and lifelong disabilities. The epidemiology of congenital abnormalities varies around the world and little information is available from Latin America.</p> <p>Methods: This is an epidemiological, descriptive, cross-sectional study with data from the Department of Informatics of the Unified Health System (DATASUS) on Congenital diaphragmatic hernia (CDH), esophageal atresia (EA) and gastroschisis (GS) in South Brazil from 2009 to 2019.</p> <p>Results: The incidence of CDH is 0.93 cases, while EA is 0.47 and GS is 2.87, all per 10,000 live births. There is an association between all the malformations and premature birth, cesarean delivery, low birth weight, and low Apgar scores. Both EA and GS are associated with maternal age, EA with older, and GS with younger mothers. While EA is associated with multiple pregnancies, GS is associated with fewer years of maternal formal education, single parenting, and a lower number of prenatal consultations. CDH is associated with the male sex and black ethnicity.</p> <p>Conclusion: This large population-based study estimates the prevalence and demographic factors associated with CDH, EA, and GS, and extends the limited descriptive epidemiologic information available.</p> Julia Berno Oliveira Kathleen Russi Sabrina Kosinski Gustavo Flacon Shiguihara Luciano Poliseli Gabriel Seba Karina Miura da Costa Copyright (c) 2023 Julia Berno Oliveira, Kathleen Russi, Sabrina Kosinski, Gustavo Flacon Shiguihara, Luciano Poliseli, Gabriel Seba, Karina Miura da Costa 2023-04-12 2023-04-12 12 13 13 10.47338/jns.v12.1199 Early outcome analysis of Gastroschisis from a high-volume tertiary care institute in India: A prospective observational study <p>Background: Gastroschisis is one of the common congenital anterior abdominal wall defects with uncovered abdominal contents (usually intestines) protruding through it. Immediate reduction of the abdominal contents is crucial after birth because of the grave consequences of delayed management. The aim of our study was to evaluate the early outcomes of Gastroschisis at a tertiary care institute in India.</p> <p>Methods: This prospective observational study was undertaken over a one-year duration extending from January to December 2021 at our pediatric tertiary care teaching institute.</p> <p>Results: There were 30 male and 28 female patients, out of which 37 were preterm neonates. The mean birth weight was 2019?357g. Seven patients (12.07%) had major associated malformations. Fifty (86.21%) patients underwent primary skin flap closure. Staged reduction with silo was accomplished in five (8.62%) patients; three patients died during resuscitation before any therapeutic procedure could be undertaken. Among 55 (94.83%) patients with surgical procedures, only 26 (47.27%) could be salvaged with overall favorable (survival) outcomes in 44.83% of patients. Mortality was high (92.59%, 25/27) in the patients presenting with markedly edematous bowel with leathery peel.? Seventeen (29.31%, 17/58) neonates died in the first 72 hours (postoperatively) due to complications of abdominal compartment syndrome, eight (13.79%) patients died due to postoperative sepsis with thrombocytopenia, and two (3.44%) had intestinal perforation. The duration of hospital stay in neonates who survived ranged from one to four weeks.</p> <p>Conclusion: Overall survival rates in our study were 44.83% markedly in contrast to the series published in the recent literature. The outcome of preterm (premature) patients, associated intestinal atresia, presence of edematous bowel with leathery peel, patients requiring silo due to viscero-abdominal disproportion, necrotizing enterocolitis, and associated malformations, was dismal.</p> Rahul Gupta Bhairu Lal Gurjar Copyright (c) 2023 Rahul Gupta, Bhairu Lal Gurjar 2023-07-04 2023-07-04 12 20 20 10.47338/jns.v12.1197 Improvement of Broviac catheter-related outcomes after the implementation of a quality management system: A before-and-after prospective observational study <p>Background: Because of the high rates of Broviac catheter complications, we started an urgent quality process to reduce this morbidity. The aim is to assess the efficiency of the main actions we have taken in enhancing our practice and improving Broviac outcomes.</p> <p>Methods: We included all neonates and young infants requiring surgical central venous access using a Broviac tunneled catheter. We compared the catheters’ outcomes before and after the implementation of a quality program based on a nurse teaching program, patient selection, and catheter management multidisciplinary protocol. The significance threshold was set at p&lt;0.05.</p> <p>Results: We included 94 patients: 51 in the protocol group and 43 in the control group. The complication rate was reduced from 60.3% to 25.5% with p=0.001. The lifetime of the catheter was improved from 11.3 ± 4.3 days to 19.1 ± 9 days with p=0.007. The catheter infection was reduced from 65.3% to 46.1% with p≤0.001.</p> <p>Conclusion: This quality improvement project shows the utility of a quality assurance program based on careful indications and patient selection, a nursing teaching program, and a multidisciplinary catheter management protocol, in reducing Broviac catheter-related morbidity.</p> Manel Kammoun Anouar Jarraya Saloua Ammar kamel Kolsi Copyright (c) 2023 Manel Kammoun, Anouar Jarraya, Saloua Ammar, kamel Kolsi 2023-01-03 2023-01-03 12 3 3 10.47338/jns.v12.1156 Fetal Lung Interstitial Tumor (FLIT): A case series <p>Background: Fetal Lung Interstitial Tumor (FLIT) is a rare benign lung tumor. There have been 18 cases of FLIT described in the literature. FLIT is characterized by a region of arrested lung development and must be differentiated from other congenital lung lesions with poorer prognoses.</p> <p>Case Presentation: We report the first two known cases of FLIT in Australia and New Zealand. In both cases, the patients developed respiratory distress at birth requiring intubation. Imaging revealed solid lesions and echocardiography demonstrated pulmonary hypertension. The patients underwent surgical resection without any complications or recurrence.</p> <p>Conclusion: FLIT is a rare benign congenital lung tumor that can be adequately managed with surgical resection.</p> Kah Ann Ho Noemi A Fuentes-Bolanos Andrew J Gifford Ashish Jiwane Dylan Wanaguru Copyright (c) 2023 Kah Ann Ho, Noemi A Fuentes-Bolanos, Andrew J Gifford, Ashish Jiwane, Dylan Wanaguru 2023-01-03 2023-01-03 12 4 4 10.47338/jns.v12.1141 Experience with endoluminal vacuum therapy in the management of esophageal anastomotic leakage in newborns with esophageal atresia: A case series <p>Background: The management of dehiscence of esophageal anastomosis is challenging and requires a multidisciplinary approach. Endoluminal vacuum therapy (EVT) has shown promising results.</p> <p>Case Presentation: Herein we present the data of two cases with esophageal atresia who developed esophageal anastomotic leakage, during 2021-2022, and who underwent EVT. The first case had 60% dehiscence of the anastomosis, anastomotic leak repair was performed followed by esophageal EVT placement. In the second case, the dehiscence was limited to 10%, and only esophageal EVT was provided. Within four and six days of EVT, upper gastrointestinal endoscopy and fluoroscopy were performed which showed tissue proliferation in situ and the absence of contrast leakage. Both patients were able to resume oral tolerance on the 4th day.</p> <p>Conclusion: Esophageal EVT has shown promising results in the management of esophageal anastomotic leakage in newborns with esophageal atresia.</p> Carolina Santamaría-Proaño Diego Leon-Ochoa Vicente Salinas-Salinas Daniel Acosta-Bowen Daniel Acosta-Farina Copyright (c) 2023 Carolina Santamaría-Proaño, Diego Leon-Ochoa, Vicente Salinas-Salinas, Daniel Acosta-Bowen, Daniel Acosta-Farina 2023-03-03 2023-03-03 12 10 10 10.47338/jns.v12.1162 Management of persistent air leak in Neonates: A case series <p>Background: Autologous blood patch pleurodesis (ABPP) has been used in adults as an efficient and safe technique to address persistent air leak (PAL). A fibrin glue patch is also an alternative, but its elevated cost and technique can limit its routine use. Evidence of their use in the pediatric population, specifically in the neonatal age is scant.</p> <p>Case Presentation: We share our management experience in a series of 3 cases. The first 2 were treated exclusively with ABPP and showed clinical and radiographic improvement. The 3rd case, due to the persistence of the air leak, required extended thoracotomy and fibrin patch placement.</p> <p>Conclusion: The use of ABPP as an alternative for the treatment of neonates with PAL is a safe and efficient technique. The procedure is replicable and can be done at the bedside at a low cost. A fibrin glue patch should be considered as an alternative option when ABPP fails to resolve the leak.</p> Jimmy Israel Andrade- Montesdeoca Vicente Salinas- Salinas Daniel Acosta- Farina Daniel Acosta- Bowen Copyright (c) 2023 Jimmy Israel Andrade- Montesdeoca, Vicente Salinas- Salinas, Daniel Acosta- Farina, Daniel Acosta- Bowen 2023-05-28 2023-05-28 12 17 17 10.47338/jns.v12.1200 Iatrogenic esophageal perforation in infants: How to avoid thoracotomy? A case series <p>Background: Esophageal perforation is uncommon and often iatrogenic in the neonatal period, with premature and low birth weight infants (&lt;1500 g) being particularly susceptible. It usually occurs at the pharyngoesophageal junction and can be confused with esophageal atresia due to respiratory signs and excessive salivation. Diagnostic evaluation and treatment are still debated.</p> <p>Case Presentation: Two neonatal cases of iatrogenic esophageal perforation are described. The suspected diagnosis was confirmed only with thoracotomy. Diagnostic difficulties and therapeutic modalities are discussed.</p> <p>Conclusion: These two cases show the importance of the clinical clues (anamnesis and clinical findings) to suspect the diagnosis of esophageal perforation.</p> Riccardo Rizzo Filomena Valentina Paradiso Sara Silvaroli Lorenzo Nanni Copyright (c) 2023 Riccardo Rizzo, Filomena Valentina Paradiso, Sara Silvaroli, Lorenzo Nanni 2023-06-09 2023-06-09 12 18 18 10.47338/jns.v12.1181 Neonatal osteomyelitis: A case series <p>Background: Osteomyelitis in the neonatal age group is a rare entity. Its presentation and progression are quite different from osteomyelitis in adults, adolescents, and even children. Due to vague clinical features and the late appearance of changes on X-rays, the diagnosis often gets missed. Additionally, there is a risk of permanent damage to bones and joints.</p> <p>Case Presentation: Our experience of 3 such interesting cases showed the diagnostic dilemma involved in neonatal osteomyelitis. All 3 cases presented as cellulitis or subcutaneous abscess initially as x-ray changes appeared late (7-10 days after onset of disease). All the babies needed surgical debridement. The average duration of antibiotics given was 35.5 days. No residual sequelae were reported for up to 2 years.</p> <p>Conclusion: Neonatal osteomyelitis needs a high index of suspicion especially in late-onset neonatal sepsis or prolonged septicemia. This case series emphasizes the need for a low threshold for suspicion and early treatment to avoid permanent disability.</p> Parveen Kumar Ankur Bhardwaj Anil Agarwal Divyamedha Agarwal Copyright (c) 2023 Parveen Kumar, Ankur Bhardwaj, Anil Agarwal, Divyamedha Agarwal 2023-07-26 2023-07-26 12 22 22 10.47338/jns.v12.1231 Extrathoracic esophageal elongation with Foker technique in patients with Type-A esophageal atresia. A case series <p>Background: Long-gap esophageal atresia (EA) is not amenable to primary anastomosis though the goal of surgical treatment is to restore the patency in the native esophagus; the Foker technique is one of the methods that can accomplish it.</p> <p>Case Presentation: This case series consists of three patients who presented with a type-A long-gap EA. Extrathoracic esophageal elongation was achieved using the Foker technique. During the first stage, we utilized pledgeted sutures reinforced with titanium clips for elongation that began five days after the surgery. As the elongation progressed, and the gap between esophageal pouches decreased, we restored the continuity of the esophagus. On follow-up, all patients needed pneumatic dilatation of the esophagus.</p> <p>Conclusion: The Foker technique successfully restored the esophageal continuity using the native esophagus in our patients with esophageal atresia.</p> Mei-Chun Lin Veronica Polit-Guerrero Jimmy Andrade-Montesdeoca Daniel Acosta-Farina Vicente Salinas-Salinas Daniel E. Acosta Copyright (c) 2023 Mei-Chun Lin, Veronica Polit-Guerrero, Jimmy Andrade-Montesdeoca, Daniel Acosta-Farina, Vicente Salinas-Salinas, Daniel E. Acosta 2023-09-06 2023-09-06 12 27 27 10.47338/jns.v12.1221 A case of Aphallia associated with neonatal intestinal obstruction Omar Ajaj Copyright (c) 2023 Omar Ajaj 2023-01-06 2023-01-06 12 6 6 10.47338/jns.v12.1119 Constrained evidence-based practice Laraib Amjad Dudrah Muhammad Bilal Mirza Copyright (c) 2023 Laraib Amjad Dudrah, Muhammad Bilal Mirza 2023-01-03 2023-01-03 12 1 1 10.47338/jns.v12.1174