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 Neonatal abdominal cocoon arising from atypical sequelae of intestinal malrotation: A case report <p>Background: Abdominal cocoon (AC) is the partial or complete encasement of the intestines and sometimes other abdominal organs by a fibro-collagenous sac causing varied presentations of intestinal obstruction. It has been found in all age groups from neonates to the elderly although neonatal AC is quite rare and only very few cases have been reported. In neonates, the presentation could mimic other causes of partial or complete intestinal obstruction and preoperative diagnosis is usually difficult.</p> <p>Case Presentation: We report an atypical sequela of intestinal malrotation causing neonatal intestinal obstruction due to omental encasement of the small and large bowel. The diagnosis was made intraoperatively though contrast gastrointestinal series suggested the partial obstruction at the duodenal-jejunal level. The patient made a good postoperative recovery after extraction of the bowel from the cocoon (omental sac), partial omentectomy, and Ladd’s procedure.</p> <p>Conclusion: A neonatal abdominal cocoon caused by an omental encasement in a malrotated intestine is a unique presentation and a rare cause of neonatal intestinal obstruction.</p> LO Abdur-Rahman OA Ojajuni TK Raji Copyright (c) 2022 LO Abdur-Rahman, OA Ojajuni , TK Raji 2022-06-07 2022-06-07 11 16 16 10.47338/jns.v11.1057 Primary neonatal sacrococcygeal neuroblastoma masquerading as a teratoma: A case report <p>Background: Neonatal tumors comprise about 2% of all pediatric malignancies, with neuroblastoma having the highest incidence. Neuroblastoma involving the adrenal medulla and sympathetic ganglia is the most typical scenario in infancy, while the pelvic variant is rare. We report this case because of the unusual and rare presentation of neuroblastoma in a newborn baby mimicking sacrococcygeal teratoma.</p> <p>Case Presentation: A newborn male baby presented with a firm sacral mass, about 5 x 7 cm, with normal overlying skin. MRI revealed an intrapelvic mass extending to the sacral region encasing the coccyx. After preparation, complete tumor excision was performed, and the diagnosis of neuroblastoma was confirmed by histological and immunohistochemical study.</p> <p>Conclusion: Primary neonatal neuroblastoma presenting as a sacrococcygeal mass is a rare and atypical clinical finding of neuroblastoma. It is hard to diagnose this sort of tumor preoperatively unless the mass is subjected to histological and immunohistochemical analysis after tumor excision.</p> Obay A Edan Nazar MT Jawhar Copyright (c) 2022 Obay A Edan, Nazar MT Jawhar 2022-08-25 2022-08-25 11 25 25 10.47338/jns.v11.1113 A complicated tale of an acquired tracheoesophageal fistula: A case report <p>Background: Esophageal atresia (EA) with distal trachea-esophageal fistula (TEF), the most common variety of EA, is managed by primary end-to-end anastomosis. Recurrent TEF constitutes the most difficult-to-manage complication of the primary repair and has an incidence of 2% to15%.</p> <p>Case Presentation: We present a case of rare recurrent TEF after primary repair of EA. The difficulties faced in view of the COVID pandemic and difficult diagnosis are discussed. We share our experience in the successful management of acquired TEF and lessons learned.</p> <p>Conclusion: Recurrent trachea-esophageal fistula is one of the rare and challenging complications to manage. The surgical option carries the best overall prognosis.</p> Vivek Manchanda Mamta Sengar Parveen Kumar Copyright (c) 2022 Vivek Manchanda, Mamta Sengar, Parveen Kumar 2022-11-14 2022-11-14 11 31 31 10.47338/jns.v11.1108 Multiple hamartomas of the oral cavity with bifid tongue and cleft palate: A unique observation <p>Background: Hamartomas are developmental tumor-like malformations, comprising a mixture of cytologically mature tissues that are indigenous to their anatomical location. Within the oral cavity, these lesions are usually multifocal, relatively small, and asymptomatic, and have been frequently linked to present as a manifestation of the oro-facial-digital-syndrome.</p> <p>Case Presentation: A 2-day-old female newborn was referred with two masses protruding from the oral cavity, feeding difficulties, and dribbling of milk during feeding. The patient had no dysmorphic features and no obvious associated anomalies. On careful examination, there was one mass protruding from the undersurface of a bifid tongue with another larger mass that seemed to originate from the hard palate. Complete surgical excision of both masses and repair of the bifid tongue were done to relieve the baby’s feeding difficulties. Histopathological examination of both specimens confirmed the diagnosis of multiple hamartomas.</p> <p>Conclusion: The occurrence of multiple and large oral hamartomas in newborns might result in feeding difficulties that necessitate urgent surgical intervention. The association of lingual and palatal hamartomas, with bifid tongue and cleft palate, is a unique observation that is not reported in the English literature.</p> Moaied Hassan Copyright (c) 2022 Moaied Hassan 2022-11-25 2022-11-25 11 33 33 10.47338/jns.v11.1144 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 Ruptured giant sacrococcygeal teratoma Omar Ajaj Copyright (c) 2022 Omar Ajaj 2022-05-24 2022-05-24 11 17 17 10.47338/jns.v11.1083 Congenital scaphoid megalourethra Omar A Ajaj Copyright (c) 2022 Omar A Ajaj 2022-09-18 2022-09-18 11 27 27 10.47338/jns.v11.1134 Idiopathic congenital lymphedema in a neonate Sengua Koipapi David Msuya Joshua Tadayo Jay Lodhia Copyright (c) 2022 Sengua Koipapi, David Msuya, Joshua Tadayo, Jay Lodhia 2022-11-27 2022-11-27 11 34 34 10.47338/jns.v11.1140 Managing sacrococcygeal teratoma in a resource constrained setting Jean de Dieu Tumusifu Manegabe Florent Tshiwid A Zeng Ghislain Maheshe Balemba Bijoux Safi Matabaro Etienne Kijibwami Birindwa Léon-Emmanuel Mubenga Mukengeshai Fabrice Cikomola Gulimwentuga Copyright (c) 2022 Jean de Dieu Tumusifu Manegabe, Florent Tshiwid A Zeng, Ghislain Maheshe Balemba, Bijoux Safi Matabaro, Etienne Kijibwami Birindwa, Léon-Emmanuel Mubenga Mukengeshai, Fabrice Cikomola Gulimwentuga 2022-06-28 2022-06-28 11 21 21 10.47338/jns.v11.1097 Large defect size is associated with 30-day mortality following surgical repair of congenital diaphragmatic hernia Mohamed Zouari Hana Ben Ameur Emna Krichen Najoua Kraiem Mahdi Ben Dhaou Riadh Mhiri Copyright (c) 2022 Mohamed Zouari, Hana Ben Ameur, Emna Krichen, Najoua Kraiem, Mahdi Ben Dhaou, Riadh Mhiri 2022-06-26 2022-06-26 11 20 20 10.47338/jns.v11.1098 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 Risk factors for early surgical intervention in neonates with gastroesophageal reflux disease <p>Background: Surgical intervention in neonates with Gastro-esophageal Reflux Disease (GERD) is usually reserved for failure of medical management or those having life-threatening complications of GERD. The optimal timing of intervention is still debatable. We aimed to identify the high-risk neonates with GERD requiring early surgical intervention.</p> <p>Methods: This prospective cohort study was conducted at NICU and Pediatric Surgery Department, Ain Shams University, from June 2017 to June 2020, and enrolled the neonates and infants below 2 months with symptoms and signs suggestive of GERD. Demographic data, clinical history, medical management, need for antireflux surgery, and outcomes were recorded.</p> <p>Results: In this study, 40 patients were enrolled and all were started on medical treatment. After the failure of medical management or life-threatening complications, 12 of these underwent anti-reflux surgery. In the medical group, six patients suffered from major complications (bronchopulmonary dysplasia and sepsis) and four mortalities. In the surgical group, three mortalities related to the development of bronchopulmonary dysplasia due to prolonged ventilation prior to surgery were recorded. The need for surgical intervention was significantly associated with younger gestational age (p = 0.001), younger age at presentation (p = 0.006), and lower weight at presentation (p = 0.034).</p> <p>Conclusion: Medical treatment of more than 35 days with unsatisfactory response, low birth weight, gestational age (≤32 weeks), and NICU admission in the first 10 days of life are considered high-risk factors for early anti-reflux surgery in neonates.</p> Shady S Shokry Khaled M El-Asmar Mohamed M Dahab Tarek A Hassan Copyright (c) 2022 Shady S Shokry, Khaled M El-Asmar, Mohamed M Dahab, Tarek A Hassan 2022-06-24 2022-06-24 11 19 19 10.47338/jns.v11.1033 Dismal outcome of gastroschisis in a resource-limited country in West Africa: Relevant issues and what to expect? <p>Background: Gastroschisis often has a fatal outcome in developing countries. Its outcome is taken as an indicator of the level of healthcare in a particular healthcare facility. The aim was to study the outcome of the management of gastroschisis and to identify the main challenges of its treatment in a country with limited resources.</p> <p>Methods: This is a prospective and descriptive study conducted over a period of 4 years (2016-2020). It included all the neonates admitted to the two referral hospitals of our country with the diagnosis of gastroschisis. Each of the university hospitals had a neonatology unit. Parenteral nutrition and assisted ventilation were not available.</p> <p>Results: Twenty patients were admitted to our hospitals with an annual frequency of five cases. The sex ratio (M:F) was 1.5. Only one of the 20 mothers (5%) of the patients had an antenatal diagnosis and was the only one born in a university hospital. The remaining (19-95%) were referred to a university hospital after their birth. None of the 20 patients had received parenteral nutrition. Surgically, seven babies (35%) had benefited from the placement of a silo with progressive reduction of the bowels. The mortality of gastroschisis was 100% and the average life span of the patients was 4.5 days [1-20 days].</p> <p>Conclusion: It is important to act appropriately on the whole chain of management of gastroschisis from antenatal diagnosis to treatment so that this pathology is no longer fatal for newborns in countries with limited resources.</p> Cedric Bignon Ulrich Assouto Amoussou Sedjro Clotaire Romeo Houegban Beaudelaire Romulus Assan Nicole Enianloko Tchiakpe Michel Armand Fiogbe Antoine Seraphin Gbenou Copyright (c) 2022 Cedric Bignon Assouto, Amoussou Sedjro Clotaire Romeo Houegban, Beaudelaire Romulus Assan, Nicole Enianloko Tchiakpe , Michel Armand Fiogbe, Antoine Seraphin Gbenou 2022-08-23 2022-08-23 11 24 24 10.47338/jns.v11.1077 Risk factors for Hickman-Broviac catheter complications: An experience from a Tunisian hospital <p>Background: Hickman-Broviac catheters have improved the care of young children needing frequent and prolonged venous access, but at the same times it has substantial morbidity, particularly in a resource-constrained setup. Our study aims to describe the experience of a Tunisian hospital and investigate the main risk factors for complications.</p> <p>Methods: In this study, we included all the neonates and infants who underwent Broviac catheter insertion in the pediatric surgery department. The patients were divided into 2 groups according to the presence of complications. We compared these two groups and univariate logistic regression analyses were used to determine the risk factors for complications.</p> <p>Results: Forty-three children were included in the study. The incidence of complicated catheters was 60.4%. The following factors were significantly associated with an increased risk of complications: age 6 months [OR 3.5, 95% CI: 0.6-19.3], weight 6 kg [OR 1.54, 95% CI: 0.46-5.2], emergency circumstances [OR 1.62, 95% CI: 0.8-5.4], and antibiotic-therapy as an indication for Broviac catheter insertion [OR 1.8, 95% CI: 0.5-6.2].</p> <p>Conclusion: Complications seem to be more frequent in patients younger than 6 months and those with a weight of less than 6Kg. To reduce the morbidity related to the catheters, the indications should be carefully chosen.</p> Manel Kammoun Anouar Jarraya Hend Ketata Saloua Ammar Mohamed Zouari Chiraz Regaieg Nadia Hentati Mahdi Ben Dhaou Riadh Mhiri Copyright (c) 2022 Manel Kammoun, Anouar Jarraya, Hend Ketata, Saloua Ammar, Mohamed Zouari, Chiraz Regaieg, Nadia Hentati, Mahdi Ben Dhaou, Riadh Mhiri 2022-09-02 2022-09-02 11 26 26 10.47338/jns.v11.1120 Experience with the use of Reverdin needle in neonatal thoracoscopic congenital diaphragmatic hernia repair <p>Background: Congenital diaphragmatic hernia is the total or partial absence of the diaphragm, which can be unilateral or bilateral. Becmeur et al. in 2001 mentioned the thoracoscopic management approach for the first time.</p> <p>Methods: The medical record of neonatal CDH thoracoscopic management (using the Reverdin Needle) from January to May 2021 at Dr. Roberto Gilberto Elizalde Children's Hospital located in Guayaquil, Ecuador was retrieved. Various parameters and characteristics were studied.</p> <p>Results: Four patients were included in this study. M:F ratio was 3:1 with all having a type B left sided defect. The average duration of surgery was 157.5 minutes and 2 of them developed pulmonary hypertension in post-op period. All had good outcomes.</p> <p>Conclusion: We propose that the possibility of a successful thoracoscopic surgery in congenital diaphragmatic hernia is increased with use of the Reverdin needle.</p> Vicente Anibal Salinas-Salinas Daniel Acosta-Farina Romel Oviedo-Vargas Jorge Oliveros-Rivero Daniel Acosta-Bowen Copyright (c) 2022 Vicente Anibal Salinas-Salinas, Daniel Acosta-Farina, Romel Oviedo-Vargas, Jorge Oliveros-Rivero, Daniel Acosta-Bowen 2022-10-27 2022-10-27 11 29 29 10.47338/jns.v11.1081 Prognostic value of the oxygenation index to predict survival in infants with congenital diaphragmatic hernia <p><span style="font-weight: 400;">Background: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. We aimed to investigate the relationship between survival and oxygenation index calculated in the first 12 hours of life in neonates with CDH. </span></p> <p><span style="font-weight: 400;">Methods: Various scoring systems have been developed to predict and determine the course of the disease in this disease group with a high mortality rate. In our study, we planned to investigate the use of APGAR scores, Neonatal acute physiological perinatal spread score-II, and oxygenation index in predicting survival. Patients born in Ankara City Hospital between March 2019 and November 2021 and followed up due to congenital diaphragmatic hernia were included in the study. Preductal oxygen saturation (sPO2) was manipulated to be 80-95% and postductal &gt;70%. Target PaCO2 values were set to be 50-70 mmHg. Oxygenation index scores were calculated using the formula mean airway pressure (MAP) (cmH2O) x fraction of inspired oxygen (FiO2) (%) / partial pressure of arterial oxygen (PaO2) (mmHg).</span></p> <p><span style="font-weight: 400;">Results: The 5th-minute APGAR scores of the patients with the congenital diaphragmatic hernia in our study were lower in the non-survivors group than the survivors group (p=0.010). SNAPPE-II and OI scores were statistically significantly higher in the nonsurvivors group (p=0.003 and p=0.002).</span></p> <p><span style="font-weight: 400;">Conclusion: The oxygenation index was determined to be an independent predictive parameter in mortality (OR: 4.519 CI: 1.301-654.645, p=0.034). The results of our study show that the oxygenation index is a reliable parameter in predicting survival.</span></p> Sarkhan Elbayiyev Esra Beser Gulsum Kadioglu Simsek Bengu Karacaglar Hayriye Gozde Kanmaz Kutman Fuat Emre Canpolat Copyright (c) 2022 Sarkhan Elbayiyev, Esra Beser, Gulsum Kadioglu Simsek, Bengu Karacaglar, Hayriye Gozde Kanmaz Kutman, Fuat Emre Canpolat 2022-11-18 2022-11-18 11 32 32 10.47338/jns.v11.1107 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 Acetylcholinesterase histochemistry: A very useful technique in the diagnosis of Hirschsprung’s disease <p>Hirschsprung’s disease (HD) is a common congenital paediatric disorder. The gold standard for its diagnosis is the demonstration of the absence of ganglion cells on H&amp;E stained sections from a spastic segment of the bowel, still at times; conclusive diagnosis of HD is difficult. This study was done to assess the accuracy of rapid Hematoxylin &amp; Eosin (H&amp;E) staining and AChE histochemistry in combination for the diagnosis of HD, especially in frozen section specimens. Samples from 36 clinically suspected HD cases were evaluated for the presence or absence of ganglion cells on H&amp;E staining on both fresh-frozen and paraffin-embedded sections, whereas AChE staining was done on frozen sections only. Of the 36 cases of frozen section specimens from the spastic region of the colon, GCs were absent in 28 cases on H&amp;E staining while positive staining patterns on AChE histochemistry were observed in 29 cases. Formalin-fixed paraffin-embedded sections showed the absence of GC on H&amp;E staining in 28 cases. The sensitivity and specificity of frozen sections with rapid H&amp;E were 77.78% and 81.82% while the sensitivity and specificity of AChE histochemistry were 80.56% and 81.82% respectively in the diagnosis of HD. Application of AChE histochemistry as an ancillary technique on frozen sections specimens of HD in combination with rapid H&amp;E staining is very useful for definitive diagnosis of HD.</p> Brijesh K Tripathi Amrita Ghosh Vaibhav Pandey Ajay N Gangopadhyay Sarita Chawdhary Shiv P Sharma Copyright (c) 2022 Brijesh K Tripathi, Amrita Ghosh, Vaibhav Pandey, Ajay N Gangopadhyay, Sarita Chawdhary, Shiv P Sharma 2022-06-07 2022-06-07 11 18 18 10.47338/jns.v11.1026 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 Rectal Atresia an uncommon entity: Experience of three cases <p>Background: Rectal atresia (RA) is a unique and rare congenital malformation contributing to about 1% of anorectal malformations. It may be associated with an abnormal sacrum and a presacral mass. The sphincter mechanism in these cases is well developed. Different surgical procedures have been described for correction of this anomaly, with variable outcomes.</p> <p>Case Presentation: We present three cases of rectal atresia with their management. All the patients presented in early neonatal life with failure to pass meconium. All the patients underwent colostomy in neonatal life as initial management. Definitive surgery was performed later in all patients. All the patients are doing fine on follow-up with good continence.</p> <p>Conclusion: The Posterior Sagittal Approach with the division of septum/tissue between the rectum and anal canal and end-end anastomosis gives excellent results.</p> Raashid Hamid Shoib Ahmad Nisar Bhat Copyright (c) 2022 Raashid Hamid, Shoib Ahmad, Nisar Bhat 2022-10-01 2022-10-01 11 28 28 10.47338/jns.v11.1067 Congenital pyloric atresia with epidermolysis bullosa: A case series <p>Background: Carmi syndrome is the name given to the association of congenital pyloric atresia and epidermolysis bullosa. It has a high mortality.</p> <p>Case series: We report 3 neonates with features of multiple skin blisters and a classical X-ray picture of a single bubble appearance. Two of them underwent surgery while 1 succumbed to sepsis in the pre-operative period. One baby had delayed mortality and the other is doing well in follow-up.</p> <p>Conclusions: Carmi syndrome should be kept as a differential diagnosis in neonates with skin blisters and feed intolerance. Early recognition with prompt medical and surgical management may contribute to a successful outcome.</p> Shishir Kumar Vivek Manchanda Parveen Kumar Rohit H Bhandari Copyright (c) 2022 Shishir Kumar, Vivek Manchanda, Parveen Kumar, Rohit H Bhandari 2022-11-06 2022-11-06 11 30 30 10.47338/jns.v11.1071 Double meningomyelocele - a rare variant of neural tube defect: A case series <p>Background: A neural tube defect is a common congenital malformation and it commonly presents as an isolated cystic swelling on the back, anywhere from occiput to sacrum. However, multiple neural tube defects are rare with less than 100 cases reported worldwide.</p> <p>Case Presentation: We are reporting two cases of multiple neural tube defects that presented in the newborn period with a history of concurrent swellings along the midline on the back. They were evaluated with ultrasonography and the diagnosis of double meningomyelocele was confirmed. Subsequently, they were operated on, both the lesions were excised, and the defects were repaired simultaneously.</p> <p>Conclusion: Double meningomyelocele is a rare form of neural tube defect. Due to its rarity, exact embryogenesis is not known and thus, there is a need for further study on its embryology.</p> MD Mokarram Ali Yogender Singh Kadian Copyright (c) 2022 MD MOKARRAM ALI, Yogender Singh Kadian 2022-11-29 2022-11-29 11 35 35 10.47338/jns.v11.1126 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 Coblator assisted marsupialization of vallecular cyst Pradeep Kumar Lakshmi Venkitaraman Copyright (c) 2022 Pradeep Kumar, Lakshmi Venkitaraman 2022-06-14 2022-06-14 11 15 15 10.47338/jns.v11.1066 Heteropagus parasitic twins – a case of omphalopagus with major omphalocele and congenital heart disease Sofia Morão Filipa Marujo Petra Loureiro Daniel Virella Rui Alves Copyright (c) 2022 Sofia Morão, Filipa Marujo, Petra Loureiro, Daniel Virella, Rui Alves 2022-07-09 2022-07-09 11 22 22 10.47338/jns.v11.1091 Mucormycosis of the colon in a premature neonate Pradeep Kajal Namita Bhutani Kirti Saini Anjali Sindhu Copyright (c) 2022 Pradeep Kajal, Namita Bhutani, Kirti Saini, Anjali Sindhu 2022-07-17 2022-07-17 11 23 23 10.47338/jns.v11.1085 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 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 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