Journal of Neonatal Surgery https://www.jneonatalsurg.com/ojs/index.php/jns <p class="style58" style="text-align: justify; line-height: 16.5pt; background: white; margin: 12.0pt 0in 12.0pt 0in;"><span style="font-size: 11.5pt; font-family: 'Arial',sans-serif; color: black;"><strong>Journal of Neonatal Surgery (ISSN: 2226-0439)</strong> is a peer-reviewed, open-access, electronic journal promoting the dispersion of quality research in Neonatal Surgery. It is the only journal dedicated to Neonatal Surgery- a developing specialty. The journal also provides an opportunity for learning "Medical Writing" for young pediatric and neonatal surgeons. Our editorial team works hard to guide new writers in this field. The journal publishes quality research that will improve outcomes of neonatal surgery, especially in resource-constrained settings. Our main aim is to reduce morbidity and mortality of neonatal surgery by publishing the latest trends in this discipline, in a special context to developing countries. We invite pediatric and neonatal surgeons for their quality contributions to the Journal of Neonatal Surgery and for helping us achieve these goals.</span></p> en-US <h3>You are free to:</h3> <ul class="license-properties"> <li class="license share"><strong>Share</strong> — copy and redistribute the material in any medium or format</li> <li class="license remix"><strong>Adapt</strong> — remix, transform, and build upon the material for any purpose, even commercially.</li> </ul> <p><strong>Terms:</strong></p> <ul> <li><strong>Attribution</strong> — You must give <a id="appropriate_credit_popup" class="helpLink" tabindex="0" title="" href="https://creativecommons.org/licenses/by/4.0/" data-original-title="">appropriate credit</a>, provide a link to the license, and <a id="indicate_changes_popup" class="helpLink" tabindex="0" title="" href="https://creativecommons.org/licenses/by/4.0/" data-original-title="">indicate if changes were made</a>. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.</li> <li><span id="by-more-container"></span><strong>No additional restrictions</strong> — You may not apply legal terms or <a id="technological_measures_popup" class="helpLink" tabindex="0" title="" href="https://creativecommons.org/licenses/by/4.0/" data-original-title="">technological measures</a> that legally restrict others from doing anything the license permits.</li> </ul> blmirza@gmail.com (Dr. Muhammad Bilal Mirza) drusamaaziz@gmail.com (Usama Aziz) Tue, 03 Jan 2023 03:02:01 -0500 OJS 3.2.1.4 http://blogs.law.harvard.edu/tech/rss 60 Improvement of Broviac catheter-related outcomes after the implementation of a quality management system: A before-and-after prospective observational study https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1156 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1156 Tue, 03 Jan 2023 00:00:00 -0500 Triple atresia: Staged repair https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1105 Meryem Unal, Muhammad Fadli Abdullah, Hazlina Mohd Khalid, Mughni Bahari Copyright (c) 2023 Meryem Unal, Muhammad Fadli Abdullah, Hazlina Mohd Khalid, Mughni Bahari https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1105 Tue, 03 Jan 2023 00:00:00 -0500 Poor outcomes in congenital short bowel syndrome with intestinal malrotation: Experience from a developing country https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1182 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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1182 Tue, 04 Apr 2023 00:00:00 -0400 Re: Constrained evidence-based practice https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1208 Amit Trivedi, Nadia Badawi, Gordon Thomas Copyright (c) 2023 Amit Trivedi, Nadia Badawi, Gordon Thomas https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1208 Tue, 25 Apr 2023 00:00:00 -0400 Fetal Lung Interstitial Tumor (FLIT): A case series https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1141 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1141 Tue, 03 Jan 2023 00:00:00 -0500 Experience with endoluminal vacuum therapy in the management of esophageal anastomotic leakage in newborns with esophageal atresia: A case series https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1162 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1162 Fri, 03 Mar 2023 00:00:00 -0500 Management of persistent air leak in Neonates: A case series https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1200 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1200 Sun, 28 May 2023 00:00:00 -0400 Intrauterine toes gangrene in a neonate https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1186 Fariba Hemmati, Hamide Barzegar Copyright (c) 2023 Fariba Hemmati, Hamide Barzegar https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1186 Sun, 14 May 2023 00:00:00 -0400 A case of Aphallia associated with neonatal intestinal obstruction https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1119 Omar Ajaj Copyright (c) 2023 Omar Ajaj https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1119 Fri, 06 Jan 2023 00:00:00 -0500 Short Bowel Syndrome in neonates and early infancy https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1148 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1148 Sat, 14 Jan 2023 00:00:00 -0500 Nucleated red blood cells as a potential biomarker for predicting spontaneous intestinal perforation in premature infants https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1159 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1159 Tue, 31 Jan 2023 00:00:00 -0500 Factors associated with cholestasis after surgery for congenital duodenal atresia https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1158 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1158 Thu, 23 Mar 2023 00:00:00 -0400 Epidemiology of congenital diaphragmatic hernia, esophageal atresia, and gastroschisis in South Brazil https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1199 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1199 Wed, 12 Apr 2023 00:00:00 -0400 Constrained evidence-based practice https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1174 Laraib Amjad Dudrah, Muhammad Bilal Mirza Copyright (c) 2023 Laraib Amjad Dudrah, Muhammad Bilal Mirza https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1174 Tue, 03 Jan 2023 00:00:00 -0500 Spontaneous perforation of Meckel’s diverticulum causing a partial small bowel obstruction: A case report https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1127 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1127 Mon, 09 Jan 2023 00:00:00 -0500 Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1165 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1165 Tue, 10 Jan 2023 00:00:00 -0500 Two-stage surgical management of horseshoe lung associated with congenital pulmonary airway malformation in a neonate: A case report https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1215 <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 https://creativecommons.org/licenses/by/4.0 https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1215 Fri, 21 Apr 2023 00:00:00 -0400