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 peer-reviewed, open access, electronic journal that promotes the dispersion of quality research in the field of Neonatal Surgery. It is the only journal, fully dedicated to Neonatal Surgery- a developing specialty. The journal also provides an opportunity for learning “Medical Writing” to 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 the developing countries. We invite pediatric and neonatal surgeons for their quality contributions to the Journal of Neonatal Surgery and help 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> Umbilical cord hematoma Nadji Boughaba Copyright (c) 2021 nadji Boughaba 2021-01-09 2021-01-09 10 4 4 10.47338/jns.v10.915 Phytobezoar causing intestinal obstruction in a neonate: A case report <p>Background: Phytobezoars are concretions of non-digestible vegetative matter in the gastroin­testinal tract and are a rare cause of intestinal obstruction in children.</p> <p>Case presentation: We report a case of intestinal obstruction in a 2-day-old neonate with no specific radiological features pointing to any common etiology. On exploratory laparotomy, a swollen raisin was found impacted in the ileum causing intestinal obstruction. The history taken in retrospect revealed that the elder sibling had witnessed her father perform a traditional ritual of putting a drop of honey into the mouth of the newborn and she imitated the same with a raisin, which led to the obstruction.</p> <p>Conclusion: A careful detailed history of local traditional rituals is at times, the most important pointer towards the etiology of a clinical condition. The basic clinical skill of history taking is still very important, despite the availability of advanced radiological investigations.</p> Ravi Patcharu Karunesh Chand Badal Parikh Copyright (c) 2020 Ravi Patcharu, Karunesh Chand, Badal Parikh 2020-12-31 2020-12-31 10 3 3 10.47338/jns.v10.704 Non-immune hydrops fetalis complicating bronchopulmonary sequestration: A case report <p>Background: Non-immune hydrops (NIH) associated with bronchopulmonary sequestration (BPS) is quite rare with a 95% risk of intrauterine fetal death, without a fetal intervention.</p> <p>Case Presentation: We describe a case of an antenatally diagnosed extralobar BPS with severe NIH, who underwent fetal thoracentesis, but had worsening of NIH requiring an emergency cesarean section. Postnatally, the baby required skillful intensive care management and timely surgical management in the form of a sequestrectomy.</p> <p>Conclusion: We report the smallest neonate with antenatally diagnosed NIH complicating BPS treated successfully by early neonatal surgery.</p> Jui Mandke Vandana Bansal Pradeep Shenoy Haribalakrishna Balasubramanian Copyright (c) 2021 Jui Mandke, Dr. Vandana Bansal, Dr. Pradeep Shenoy, Dr. Haribalakrishna Balasubramanian 2021-01-10 2021-01-10 10 5 5 10.47338/jns.v10.556 Oxidized regenerated cellulose gauze as a hemostat in infantile hypertrophic pyloric stenosis <p>Background: The Ramstedt pyloromyotomy is a standard procedure for infantile hypertrophic pyloric stenosis (IHPS). However, continuous postoperative bleeding may occur from the pyloromyotomy site without the use of any hemostatic management. We aim to analyze the pre-operative and post-operative hemogram values with and without the use of oxidized regenerated cellulose gauze as a hemostat in IHPS. </p> <p>Methods: A prospective study performed from January 2019 to March 2020. The patients were randomly distributed by chit method into two groups: Group A (Control) without the use of hemostat and Group B (Case) with oxidized regenerated cellulose gauze as a hemostat. </p> <p>Results: There were 26 patients with 19 males and 7 females. There were 13 patients in Group A and 12 in Group B; while one patient succumbed before surgery. Ramstedt’s pyloromyotomy was performed in 25 (96.16%) patients. A total of 7 (28%) postoperative complications were recorded in our patients. One patient in group A with intraperitoneal blood collection required blood transfusion for anemia caused by peritoneal bleeding. There was one postoperative death (group A). Significant statistical differences between preoperative and postoperative RBC (106/mm3), hemoglobin (g/dl), and hematocrit (%) levels were observed in group A but insignificant differences among the values in group B.</p> <p>Conclusions: We recommend that oxidized regenerated cellulose should be applied to the pyloromyotomy site to minimize perioperative bleeding associated with the Ramstedt procedure. It appears to be a safe, easily available, easy to use, and effective hemostatic agent available for IHPS.</p> Rahul Gupta Anu Bhandari Copyright (c) 2020 Rahul Gupta, Anu Bhandari 2020-12-31 2020-12-31 10 2 2 10.47338/jns.v10.705 Predictors of recurrent strictures after oesophageal atresia repair <p>Background: Anastomotic strictures continue to complicate the outcome after oesophageal atresia (OA) repair. Multiple variables contribute to the development of strictures, and oesophageal dilatations are the mainstay of treatment. We aim to analyse the factors that impact the timing for initiation of oesophageal dilatations, the duration, frequency, and success of the dilatation regimen for OA.</p> <p>Methods: It was a retrospective review of data (13-year) of children who underwent repair for Gross type C OA (OA with distal tracheo-oesophageal fistula). The delayed anastomosis was performed for long gap OA. Leaks were clinically obvious or identified on contrast swallow. Strictures that were symptomatic underwent oesophageal dilatations.</p> <p>Results: The data of 72 children were analysed. The stricture rate was 37.5%. Ten had delayed repair, out of which 50% developed strictures compared to 35.5% who had a primary repair (P=0.48). There was no statistical difference in the mean birth weight (BW) and gestational age (GA) of children who developed strictures compared to those with no strictures (2.74kg vs 2.63Kg; P =0.548; 37.4 weeks vs 37.3 weeks; P=0.9). Children that underwent a delayed repair required significantly more dilatation sessions (12 vs 2 median sessions; P =0.001) and had a significantly prolonged duration of treatment (610 vs 63 median days; P = 0.013). There was a significant negative correlation between the GA and BW and the number of dilatation sessions required (P=0.03 and P=0.02, respectively). Linear regression revealed that delayed repair was the most important factor related to the number of dilatation sessions required (p &lt;0.001); this was followed by lower GA or BW (p = 0.0265) and early onset of dilatations (p=0.0471).</p> <p>Conclusions: The early onset of oesophageal dilatation for oesophageal strictures or when they occur in premature babies or those that have had a delayed repair, it should be anticipated that they would be refractory or recurrent.</p> Olugbenga Aworanti Ezio Giulio Landi Alan Mortell Copyright (c) 2021 Olugbenga Aworanti, Ezio Giulio Landi, Alan Mortell 2021-01-20 2021-01-20 10 8 8 10.47338/jns.v10.919 Spontaneous pneumoperitoneum: Discerning from radiological imaging <p>Background: Pneumoperitoneum without any gastrointestinal (GI) perforation or peritonitis is entitled spontaneous pneumoperitoneum. We aimed to describe a radiological perspective in spontaneous pneumoperitoneum.</p> <p>Methods: This case series presented data of 4 cases of spontaneous pneumoperitoneum managed at our institution.</p> <p>Results: There were 85 patients with a provisional diagnosis of necrotizing enterocolitis (NEC) and/or pneumoperitoneum. Out of these, there were 4 patients with the final diagnosis of spontaneous pneumoperitoneum; three males and 1 female. At presentation, respiratory distress was seen in 3. It was preceded by mechanical ventilation in 3 patients. All 4 had soft abdominal distension, absence of features suggestive of peritonitis, and the presence of free air with an absence of air-fluid level in peritoneal cavity on erect abdominal radiographs. The Rigler sign was present in 3 patients. Abdominocentesis followed by abdominal drain placement was performed in 2 patients. Laparotomy was performed in 1 patient which could not point to any pathology (negative). An unfavorable outcome was seen in one patient with associated esophageal atresia. No patient had any evidence (either ultrasound/radiological or on laparotomy) of leakage of contents from the GI tract.</p> <p>Conclusions: In infants, especially preterm neonates, presenting with soft abdominal distension with abrupt onset of pneumoperitoneum, without clinical features of peritonitis and preceded by mechanical ventilation, diagnosis of spontaneous pneumoperitoneum should be considered.</p> Rahul Gupta Copyright (c) 2021 Rahul Gupta 2021-01-10 2021-01-10 10 6 6 10.47338/jns.v10.930 Vanishing gastroschisis with jejunal atresia and extreme short bowel syndrome: A case series <p>Background: Vanishing gastroschisis may occur due to spontaneous partial or complete closure of anterior abdominal wall defect around the viscera, leading to small bowel ischemia and resultant entry/exit level atresia and extremely short length of the remaining bowel. The prognosis is very poor, even after aggressive surgery, and requires prolonged total parenteral nutrition.</p> <p>Case Series: We report two female neonates, one with closed and another with closing vanishing gastroschisis, associated with jejunal atresia and extreme short bowel syndrome. In both patients, the antenatal scans showed gastroschisis without the evidence of vanishing gastroschisis. In both neonates, palliative surgeries were done. Both patients died after a few days due to short bowel syndrome and sepsis.</p> <p>Conclusion: When antenatally detected gastroschisis presents with closed or closing anterior abdominal wall defect, (vanishing gastroschisis), the parents/caregivers must be counseled about the poor prognosis of this condition. A tailored approach to either palliation or aggressive therapy is essential in this rare condition.</p> Naresh Pawar Pramila Sharma Punit Singh Parihar Manika Boipai Copyright (c) 2021 Naresh Pawar, Pramila Sharma, Punit Singh Parihar, Manika Boipai 2021-01-12 2021-01-12 10 7 7 10.47338/jns.v10.932