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> Right retrocolic intrasaccular duodenum: Is it a novel variant of isolated duodenal nonrotation? A case report <p>Background: Almost all of the studies on anomalies of the midgut rotation and fixation in the literature and related sections in textbooks were designed according to Dott's classification. Focusing only on common rotation anomalies has led to the exclusion and neglect of other rare variants. Isolated pure duodenal nonrotation is such a variant.</p> <p>Case Presentation: We report a case of an unusual form of isolated pure duodenal nonrotation, in a 3-day-old newborn presenting with bilious vomiting. Ultrasonographic examination revealed the sign of 'whirlpool'. When this finding was evaluated together with bilious vomiting, midgut volvulus was considered and the patient was operated on urgently. Peroperatively, it was observed that the jejunum entered between the leaves of the terminal ileum mesentery. Proximally, the duodenum was located posterior to the right colon in a "sack". This "sack" was surrounded by thick Ladd's bands laterally, mesentery of the ascending colon medially, the posterior surface of the cecum and ascending colon anteriorly, and by the posterior abdominal wall posteriorly.</p> <p>Conclusion: In isolated duodenal nonrotation, the duodenum may be completely retro-colic. Consequently, the duodenojejunal junction and the ileocecal region may almost overlap. Unlike isolated duodenal nonrotation cases, in the surgical treatment of this variant, separation of Ladd bands alone is not sufficient, additionally, the right colon should be placed in a nonrotation position and care should be taken not to kink the terminal ileum under the cecum.</p> Mirzaman Huseynov Copyright (c) 2022 Mirzaman Huseynov 2022-01-14 2022-01-14 11 5 5 10.47338/jns.v11.978 Pulmonary lymphangiectasia a rare cause of chylothorax: A case report <p>Background: Pulmonary lymphangiectasia (PL) is a rare disease characterized by dilation of the pulmonary lymphatic vessels. PL should be considered in the differential diagnosis in infants with pleural effusion, especially in the presence of chylothorax.</p> <p>Case Presentation: A 3-week-old neonate presented with tachypnea, cough, and reluctance to feed. Work-up found bilateral chylous pleural effusion. The patient was initially managed conservatively with bilateral tube thoracostomies and octreotide, however output from chest tubes did not subside. A left thoracotomy was performed with wedge biopsy of the apical segment of the left inferior lung lobe and multiple titanium clips were used to control thoracic duct. Postoperatively the patient continued to have high chest tube output, despite placement of clips. Histology of the biopsy confirmed the diagnosis of congenital pulmonary lymphangiectasia.</p> <p>Conclusion: Pulmonary lymphangiectasia is a rare cause of chylothorax. The treatment is often challenging as found in the index case.</p> James Conner Richard Mahon Juan Camps Copyright (c) 2022 James Conner, Richard Mahon, Juan Camps 2022-04-10 2022-04-10 11 14 14 10.47338/jns.v11.1037 Jejunal ectopic pancreas in a neonate Daniel Acosta-Farina Jorge Oliveros-Rivero Manuel Cabrera-Viteri Vicente Salinas-Salinas Daniel Acosta-Bowen Copyright (c) 2022 Daniel Acosta-Farina, Jorge Oliveros-Rivero, Manuel Cabrera-Viteri, Vicente Salinas-Salinas, Daniel Acosta-Bowen 2022-01-14 2022-01-14 11 6 6 10.47338/jns.v11.1031 Safety and feasibility of delivery room cuddles in infants with surgical defects: A quality improvement project <p>Background: Delivery Room Cuddles (DRC) is a growing practice with recognized benefits for parent-infant bonding, breastfeeding rates, and infant stress responses.</p> <p>Methods: We introduced DRC at St. Mary’s NICU, Manchester, in October 2020. As part of a formal QI process, we have been continuously collecting data on all babies admitted to our NICU from the delivery suite to review rates of DRC and monitor for any beneficial effects / adverse events.</p> <p>From October 2020 to May 2021, we admitted 41 babies with known surgical defects; 56% of whom had a DRC, including intubated babies with congenital diaphragmatic hernias, and babies with open surgical defects.</p> <p>Results: There have been no adverse incidents directly related to DRC and more babies who had a DRC received breast milk than those who did not</p> <p>Conclusion: Our study demonstrates that DRC can be implemented safely in surgical babies.</p> Rebecca Evans Thomas Hogan Ranganna Ranganath Copyright (c) 2022 Rebecca Evans, Thomas Hogan, Ranganna Ranganath 2022-01-17 2022-01-17 11 8 8 10.47338/jns.v11.1056 Congenital short bowel syndrome Aditya Musham Vikram Khanna Kashish Khanna Srishti Goel Sushma Nangia Hiramani Pathak Copyright (c) 2022 ADITYA M, Vikram Khanna, Kashish Khanna, Srishti Goel, Sushma Nangia, Hiramani Pathak 2022-01-08 2022-01-08 11 4 4 10.47338/jns.v11.1041 Starting from scratch: The primary hyperacidity theory of the cause of pyloric stenosis of infancy <p>The early observations of those who first described babies with pyloric stenosis (PS) are used as a backdrop for the development of the Inherited Primary Hyperacidity theory of cause. Those early truths, uncomplicated by modern technology, have acted as a springboard for pathogenesis. Hyperacidity, male predominance, family history, self-cure, enhanced appetite, and time-sensitive presentation were all well known to the early pioneers. Any system of pathogenesis must explain all these clinical features. The Inherited Primary Hyperacidity theory does this and is a credible explanation for all the clinical features established by these early pioneers. The evidence which supports a delay in maturation of the negative feedback between gastrin and gastric acidity is presented. Such a phenomenon further supports the Primary Hyperacidity theory.</p> Ian Munro Rogers Copyright (c) 2022 Ian Munro Rogers 2022-01-14 2022-01-14 11 7 7 10.47338/jns.v11.1004 Muscle-sparing posterolateral thoracotomy for esophageal atresia Vogt Type 3b <p>Background: Posterolateral muscle cutting thoracotomy is the gold standard approach to repair esophageal atresia with distal tracheoesophageal fistula. This technique is associated with morbidities in terms of poor motor and aesthetic outcomes. We aim to share our experience with muscle-sparing skin crease incision posterolateral thoracotomy for esophageal atresia Vogt type 3b.</p> <p>Methods: It was a retrospective observational study conducted over a period of 3 years and 6 months from January 2016 to June 2019 at two tertiary care teaching institutes. All patients with esophageal atresia having distal tracheoesophageal fistula were included.</p> <p>Results: Fifty-nine neonates underwent muscle-sparing thoracotomy, with 23 males and 36 females. The 34 (58%) neonates had low birth weight. Anorectal malformation (ARM) was the most common (6) associated major malformation(18). Intraoperative findings included long gap EA (6), right aortic arch (RAA, 3), aberrant vessels (1), and long upper pouch (1). Conversion to muscle cutting approach (during early learning curve) was performed in 8 cases i.e. long gap EA (3), RAA (2), Subglottic stenosis (2), others (1). No intraoperative complication was encountered; postoperative seroma formation (related to the approach) was observed in 2 (3.4%) neonates. Most of the patients achieved satisfactory functional and aesthetic outcomes.</p> <p>Conclusions: Muscle-sparing skin crease incision posterolateral thoracotomy is a viable approach for repair of esophageal atresia with distal tracheoesophageal fistula. The technique is easy to perform with adequate exposure and provides satisfactory functional and aesthetic outcomes with relatively minimum morbidity.</p> Rahul Gupta Copyright (c) 2022 Rahul Gupta 2022-03-11 2022-03-11 11 11 11 10.47338/jns.v11.1074 Initial management of omphalocele using negative pressure wound therapy (NPWT) in Ecuador: A case series <p>Background: Omphalocele is an abdominal wall defect. Herniated organs can be small or large intestine, liver, and stomach. The use of conventional techniques has always been a challenge for the surgeon. The goal of using NPWT is to provide a quick, simple, and effective method to reduce the eviscerated content and enlarge the visceral continent.</p> <p>Case Presentation: The record of 3 patients with omphalocele was reviewed. There were two females and one male neonate. All the babies were born by C-section and were antenatally diagnosed for omphalocele. In all cases, NPWT was applied. Two cases were discharged in good condition while one patient with complex cardiac defects succumbed.</p> <p>Conclusion: NPWT is an effective and safe alternative for omphalocele management.</p> Daniel Acosta-Farina Johan Aguayo-Vistin Cristhian Cedeño-Moreira Vicente Salinas-Salinas Verónica Polit-Guerrero Jorge Oliveros-Rivero Daniel Acosta-Bowen Copyright (c) 2022 Daniel Acosta-Farina, Johan Aguayo-Vistin, Cristhian Cedeño-Moreira, Vicente Salinas-Salinas, Verónica Polit-Guerrero, Jorge Oliveros-Rivero, Daniel Acosta-Bowen 2022-02-28 2022-02-28 11 10 10 10.47338/jns.v11.1046 Functional Intestinal Obstruction of Prematurity (FIOP): Short term management results: A case series <p>Background: Functional Intestinal Obstruction of Prematurity (FIOP) is the delay or failure of meconium evacuation in premature neonates. It is associated with hypomotility in the developing intestine. It mostly presents with signs of intestinal obstruction in very low (VLBW) or extremely low birth weight (ELBW) neonates.</p> <p>Case Series: We present short-term results regarding the management of 8 premature newborns with FIOP treated with Awolaran O. et al [1] algorithm in a pediatric hospital, two of them required a surgical procedure due to conservative management failure.</p> <p>Conclusion: Early conservative management is successful in most patients with FIOP, related to symptom resolution. Surgical management should be kept for those with conservative management failure.</p> Daniel Acosta Farina Verónica Polit-Guerrero Johan Aguayo-Vistin Cristhian Cedeño-Moreira Vicente Salinas-Salinas Daniel Acosta-Bowen jorge Oliveros-Rivero Copyright (c) 2022 Daniel Acosta Farina, Verónica Polit-Guerrero, Johan Aguayo-Vistin, Cristhian Cedeño-Moreira, Vicente Salinas-Salinas, Daniel Acosta-Bowen, jorge Oliveros-Rivero 2022-03-29 2022-03-29 11 13 13 10.47338/jns.v11.1048 Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study <p>Background: Despite a decreasing global neonatal mortality, the rate in sub-Saharan Africa is still high. The contribution and the burden of surgical illness to this high mortality rate have not been fully ascertained. This study is performed to determine the overall and disease-specific mortality and morbidity rates following neonatal surgeries; and the pre, intra, and post-operative factors affecting these outcomes. </p> <p>Methods: This was a prospective observational cohort study; a country-wide, multi-center observational study of neonatal surgeries in 17 tertiary hospitals in Nigeria. The participants were 304 neonates that had surgery within 28 days of life. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measure was 30-day postoperative complication rates.</p> <p>Results: There were 200 (65.8%) boys and 104 (34.2%) girls, aged 1-28 days (mean of 12.1 ± 10.1 days) and 99(31.6%) were preterm. Sepsis was the most frequent major postoperative complication occurring in 97(32%) neonates. Others were surgical site infection (88, 29.2%) and malnutrition (76, 25.2%). Mortality occurred in 81 (26.6%) neonates. Case-specific mortalities were: gastroschisis (14, 58.3%), esophageal atresia (13, 56.5%) and intestinal atresia (25, 37.2%). Complications significantly correlated with 30-day mortality (<em>p</em> &lt;0.05). The major risk predictors of mortality were apnea (OR=10.8), severe malnutrition (OR =6.9), sepsis (OR =7. I), deep surgical site infection (OR=3.5), and re-operation (OR=2.9). </p> <p>Conclusion: Neonatal surgical mortality is high at 26.2%. Significant mortality risk factors include prematurity, apnea, malnutrition, and sepsis.</p> Hyginus Okechukwu Ekwunife Emmanuel Ameh Lukman Abdur-Rahman Adesoji Ademuyiwa Emem Akpanudo Felix Alakaloko Copyright (c) 2022 Hyginus Okechukwu Ekwunife, Emmanuel Ameh , Lukman Abdur-Rahman , Adesoji Ademuyiwa , Emem Akpanudo , Felix Alakaloko , Kefas Bwala, Ifeanyichukwu Egbuchulem , Sebastian Ekenze , Uchechukwu Ezomike , Faboya Omolara , Oluwaseun Ladipo-Ajayi , Taiwo Lawal, Christopher Lukong , Victor Modekwe , Abdulrasheed Nasir , Chigbundu Nwokoro , Dave Okafor , Philemon Okoro , Samson Olori , Emmanuel Orji, Justina Seyi-Olajide , Tunde Sholadoye , Oludayo Sowande, Jones Taiwo , Adebayo Tanimola, Jideofor Ugwu, Omolara Williams 2022-01-09 2022-01-09 11 3 3 10.47338/jns.v11.1029 Congenital intrinsic duodenal obstruction: Clinical study and predictors of neonatal surgical mortality <p>Background: This study was aimed to analyze the clinical profile and the predictors of neonatal surgical mortality of congenital intrinsic duodenal obstruction (CIDO).</p> <p>Methods: This is a case series of 67 patients with CIDO (duodenal atresia and stenosis) admitted at our teaching institute, from October 2018 to June 2020. The demographic data, clinical presentation, diagnostic methods, location &amp; type of duodenal atresia, the operative procedure performed, and neonatal surgical mortality (NSM) predictors such as birth weight, age on presentation, associated anomalies, duration of surgery, extubation after surgery, sepsis, and vasopressors support were analyzed.</p> <p>Results: Of 67 patients, 40(60%) were premature; mean weight and age at presentation were 2.06±0.6 (1-8 kg) and 6.7(1-240days), respectively. The majority of patients (59, 88%) presented with vomiting, and the most common finding on the x-ray abdomen was a double bubble sign (54, 81%). Twenty-four (36%) were associated with congenital heart disease and 19(28%) had Down’s syndrome. Type 3 duodenal atresia was the commonest finding in 43(64%) followed by type 1 in 22 (33%), and type 2 in 2(3%). In 49 (73%) Kimura’s duodenoduodenostomy, excision of web &amp; duodenoplasty in 13 (19%), and side to side duodenoduodenostomy in 4 (6%), were performed. The mean hospital stay of survivors was 9 days. Overall survival was 63%.</p> <p>Conclusion: Type 3 duodenal atresia is the commonest variety observed. The prematurity, low birth weight, associated major congenital anomalies, surgery &gt;90 minutes, delayed extubation after surgery, sepsis, and need for vasopressors support are significant predictors of NSM.</p> Pramila Sharma Naresh Pawar Arun Kumar Gupta Copyright (c) 2022 Dr. Prmila Sharma, Dr. Naresh Pawar, Dr. Arun Kumar Gupta 2022-02-20 2022-02-20 11 9 9 10.47338/jns.v11.1034 The 30-day outcome of neonates operated for esophageal atresia <p>Background: Despite great advances in the overall management of neonates with esophageal atresia (EA), many complications leading to morbidity still occurs. Most complications can be treated conservatively, but effective management is needed to reduce long-term morbidity. </p> <p>Methods: A retrospective cohort study was performed on neonates treated for EA with/without a tracheoesophageal fistula (TEF) between 2001 and 2020. Data were collected from patient records, discharge summaries, and surgical notes. The information recorded included: maternal and neonatal demographics, information regarding the diagnosis, and details surrounding the surgery.</p> <p>Results: During the 19-year study period, 53 neonates with a mean gestational age of 36.7 weeks were included for analysis. Forty-nine percent presented with an associated anomaly (most commonly, complex cardiac lesions). The majority (83%) had a primary repair on a median of day 3 of life. Nineteen neonates had a surgical complication 30 days post-repair: 7 minor (contained leaks and a chylothorax) and 12 major complications including anastomotic strictures, major anastomotic breakdowns, a recurrent TEF, and 5 surgery-related mortalities.</p> <p>Conclusions: This study showed less morbidity and mortality of neonates born with EA, despite a high incidence of associated anomalies, in a resource-restricted hospital. It is important to highlight that even with limited resources, centers in low- or middle-income countries can have good outcomes.</p> Corné de Vos L van Wyk D Sidler P Goussard Copyright (c) 2022 Corné de Vos, L van Wyk, D Sidler, P Goussard 2022-03-17 2022-03-17 11 12 12 10.47338/jns.v11.1049 Improving neonatal surgical outcome: My vision Yogesh Kumar Sarin Copyright (c) 2022 Yogesh Kumar Sarin 2022-01-06 2022-01-06 11 1 1 10.47338/jns.v11.1053