http://www.neonatalsurg.com Journal of Neonatal Surgery is an open access electronic journal related to the field of Neonatal Surgery Sun, 01 Jul 2012 00:00 am en-us http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-58.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-58.html Sun, 01 Jul 2012 00:00 am Aim: The purpose of the study was to observe the outcome of trans-fistula anorectoplasty (TFARP) in treating female neonates with anorectovestibular fistula (ARVF). Methods: A prospective study was carried out on female neonates with vestibular fistula, admitted into the surgical department of a tertiary level children hospital during the period from January 2009 to June 2011. TFARP without a covering colostomy was performed for definitive correction in the neonatal period in all. Data regarding demographics, clinical presentation, associated anomalies, preoperative findings, preoperative preparations, operative technique, difficulties faced during surgery, duration of surgery, postoperative course including complications, hospital stay, bowel habits and continence was prospectively compiled and analyzed. Anorectal function was measured by the modified Wingspread scoring as, “excellent”, “good”, “fair” and “poor”. Results: Thirty-nine neonates with vestibular fistula underwent single stage TFARP. Mean operation time was 81 minutes and mean hospital stay was 6 days. Three (7.7%) patients suffered vaginal tear during separation from the rectal wall. Two patients (5.1%) developed wound infection at neoanal site that resulted in anal stenosis. Eight (20.51%) children in the series are more than 3 years of age and are continent; all have attained “excellent” fecal continence score. None had constipation or soiling. Other 31 (79.5%) children less than 3 years of age have satisfactory anocutaneous reflex and anal grip on per rectal digital examination, though occasional soiling was observed in 4 patients. Conclusion: Primary repair of ARVF in female neonates by TFARP without dividing the perineum is a feasible procedure with good cosmetic appearance and good anal continence. Separation of the rectum from the posterior wall of vagina is the most delicate step of the operation, takes place under direct vision. It is very important to keep the perineal body intact. With meticulous preoperative bowel preparation and post operative wound care and bowel management, single stage reconstruction is possible in neonates with satisfactory results. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-55.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-55.html Sun, 01 Jul 2012 00:00 am Background: Congenital pouch colon (CPC) is a rare entity in patients of anorectal malformations (ARM) requiring special consideration as to the management. This study is aimed at evaluating the presentation, management, and the outcome of initial surgery in patients with CPC. Materials and Methods: This retrospective study was conducted in the department of Pediatric Surgery of our institute during May 2007- May 2010. The Information about the demography, clinical features, investigations, management, and the outcome of initial surgery was retrieved and analyzed. Results: There were 21 patients of CPC managed during the study period. Sixteen (76%) were males and five (24%) females (M:F 3.2:1). Mean age of presentation was 4.8 days with a range of 12 hours to 45 days. In 18 (85.7%) patients, CPC was found with high ARMs, whereas, in 3 (14.3%) patients it was associated with low ARMs. Imperforate anus with moderate to massive abdominal distension was the presentation in 16 (76%) patients. Abdominal radiographs helped in preoperative diagnosis in 8 patients. Two patients had pneumoperitoneum on abdominal radiographs. At operation, type I CPC was found in 9 (42.8%) patients, type II in 5 (23.8%), type III in 2 (9.5%) patients, and type IV CPC in 5 (23.8%) patients. In 11 (52.4%) patients, pouch was emptied and retained with proximal enterostomy. In 7 (33.3%) patients, end enterostomy with pouch excision was done. In two patients, a window colostomy was formed. In one patient, pouch was disconnected from the normal bowel and Hartmann’s pouch with end ileostomy was formed. There were 2 (9.5%) deaths in our series. Conclusion: CPC is a rare malformation. Massive abdominal distension with imperforate anus is the common presentation. Optimum management can reduce the morbidity and mortality. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-62.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-62.html Sun, 01 Jul 2012 00:00 am Aim: To compare the outcome of patients with jeuno-ileal atresia (JIA) associated with the intraoperative finding of volvulus of small bowel (group A) with that of JIA without volvulus (group B). Materials and Methods: It is a retrospective observational study conducted at one of the two units of Pediatric Surgery, in a tertiary care public hospital of India, from January 2001 to December 2010. Hospital records were retrieved and analyzed. During this time period, 65 patients with JIA were operated of which 40 (61.5%) had ileal atresia (IA) and 25 (38.5%) had jejunal atresia (JA). Eleven (16.9%) patients had associated intraoperative finding of volvulus of small bowel (Group A) and were studied and compared with group B- not associated with intraoperative findings of volvulus of small bowel (n=54). The demography, clinical features, operative findings, associated anomalies, anastomotic leakage, and outcome were compared. Results: Group A comprising of 6 boys and 5 girls, had 8 IA and 3 JA; one case each of Type 3b and Type 4 JIA was seen. Associated anomalies included meconium ileus (n=2), Down’s syndrome (n=1) and malrotation (n=1). Anastomotic leak rate was 75% for IA and 66.7% for JA. The mortality was 91% in Group A, 100% for IA and 67% for JA. Group B comprising of 37 boys and 17 girls, had 32 IA and 22 JA; 2 cases of Type 4 and 1 case of Type 3b JIA was seen. Associated anomalies were malrotation (n=2), meconium ileus (n=1), exomphalos (n=1), gastroschisis (n=1) and ileal duplication cyst (n=1). The anastomotic leak rate for JA was 8/21 (38.1%) and IA was 3/28 (10.7%); persistent obstruction was seen in 3/21(14.3%) JA and 1/28 (3.6%) IA patients. In group B, overall mortality rate was 8/22 (36.4%) for JA and 9/32 (28%) for IA. The morbidity and mortality was statistically-significant higher in group A when compared to group B. Conclusions: JIA associated with volvulus (without malrotation) is a sinister entity with a dismal outcome in our experience. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-42.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-42.html Sun, 01 Jul 2012 00:00 am Neonatal genital prolapse is a rare condition seen early in life, often in conjunction with spinal cord anomalies. We present a case of a 38-week gestational age female in whom urinary obstruction and bilateral hydronephrosis resulted from genital prolapse. We suggest that although a serious urologic outcome can potentially result from this condition, cure for both can be achieved swiftly and without major complications. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-54.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-54.html Sun, 01 Jul 2012 00:00 am Congenital segmental dilatation of colon (CSDC) is a rare malformation in neonates. A single segmental dilatation of colon is mentioned in the available case reports. Not a single case of multiple CSDC is reported hitherto. We report a case of multiple CSDC associated with cleft lip and palate, and rectal atresia. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-60.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-60.html Sun, 01 Jul 2012 00:00 am We report a case of prenatally diagnosed Fetus-in-fetu (FIF) residing in the left retro-peritoneum in a 2-week-old neonate which was also associated with ipsilateral testicular atrophy. A comparison of features differentiating FIF from a retroperitoneal teratoma, and various theories of origin of FIF are described. The causal relationship of ipsilateral atrophic testis with FIF in this case is also discussed. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-53.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-53.html Sun, 01 Jul 2012 00:00 am This is a case report of a newborn baby with gastric duplication cyst presented with non-bilious vomiting and upper abdominal distension. The diagnosis was suspected clinically and established by ultrasonography and computed tomography. The cyst was completely excised with uneventful recovery. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-65.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-65.html Sun, 01 Jul 2012 00:00 am Athena's Pages http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-61.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-61.html Sun, 01 Jul 2012 00:00 am Intralesional sclerotherapy as a primary modality of management for cystic hygroma is successfully described in literature. It has many benefits over surgical approach; recurrence being the concern of as much as 20% of patients in which apparent complete excision has been performed. Bleomycin is one of sclerosing agents used as intralesional therapy in cystic hygroma. Complete response usually occurs in multiple sessions of sclerotherapy. Rarely, complete resolution occurs with single session of bleomycin sclerotherapy. We share our experience of managing a case of cystic hygroma of neck that completely resolved with single session of bleomycin sclerotherapy. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-59.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-59.html Sun, 01 Jul 2012 00:00 am Polysplenia syndrome in association with situs inversus and intestinal atresia is rarely reported. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-38.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-38.html Sun, 01 Jul 2012 00:00 am Developing countries are not only lagging behind in health facilities but also literacy of the population. Many uneventfully manageable conditions use to present after complications have been occurred. Negligence of the poor people and their blind faith on the fraudulent quacks and peers add burden to the poor health facilities in the resource poor countries. This could be one of important reasons of higher mortality rate in our hospitals especially in neonates with poor reserves to combat these crises for long. Urinary ascites due to in-utero bladder perforation secondary to posterior urethral valves is a rare entity. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-35.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-35.html Sun, 01 Jul 2012 00:00 am Limb Threatening Constriction Ring Syndrome of Right Leg http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-51.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-51.html Sun, 01 Jul 2012 00:00 am Bilateral Choanal Atresia with Tessier Type 3 Facial Cleft: A Rare Association http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-66.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-66.html Sun, 01 Jul 2012 00:00 am Congenital Pouch colon http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-50.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-50.html Sun, 01 Apr 2012 00:00 am A new baby is like the beginning of all things-wonder, hope, a dream of possibilities- Eda J. Le Shan But what about a baby born with congenital anomaly? Even when antenatal diagnosis of a congenital anomaly is made, there is tremendous psychological impact when such a baby is born. The hopes and dreams of parents are engulfed with fear of death or long-term morbidity. The extent of intervention to correct the anomaly by the treating physician/ neonatologist/ neonatal surgeon could vary depending on where this baby was born. In the resource challenged nations like India, it may also depend on the socio-economic status of the family. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-49.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-49.html Sun, 01 Apr 2012 00:00 am The second issue of Journal of Neonatal Surgery has been successfully published. It is a matter of great pride and celebration for the editorial team. Every editor has contributed to the best of the capacity to bring forth the issue within the specified time. Professor Yogesh Kumar Sarin led us from the front; his meticulous efforts are worth a mention. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-8.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-8.html Sun, 01 Apr 2012 00:00 am Aim: To describe the management and outcome of patients with duodenal webs, managed over a period of 12 ½ years in our unit. Methods: It is a retrospective case series of 18 patients with congenital duodenal webs, managed in our unit, between 1999 and 2011. The medical record of these patients was retrieved and analyzed for demographic details, clinical presentation, associated anomalies, and outcome. Results: The median age of presentation was 8 days (range 1 day to 1.5 years). Antenatal diagnosis was made in only 2 (11.1%) patients. The commonest presentation was bilious vomiting. Associated anomalies were present in 8/18 patients, common being malrotation of gut. Down’s syndrome was seen in 2 patients and congenital heart disease in 1 patient. One patient had double duodenal webs. There was a delay in presentation of more than 5 days of life in 11/18 (61%) patients. Three patients who presented beyond neonatal age group had fenestrated duodenal membranes causing partial obstruction. In addition, the diagnosis was missed in patients operated for malrotation elsewhere (n=2), imperforate anus (n=2) and esophageal atresia with tracheo-esophageal fistula (n=1). A lateral duodenotomy with excision of the obstructive membrane was done in all patients. A trans-anastomotic tube (TAT) for enteral feeding was used in 8 patients The mortality rate was 4/18 (22%); the main causes being sepsis, prematurity, very low birth weight and associated congenital anomalies. The mean hospital stay for the 14 survivors was 18 days. Total parental nutrition (TPN) was not given to any patient. Conclusions: Congenital duodenal webs are different as the diagnosis is often missed especially in case of perforated webs. Outcome depends upon the time of presentation and associated anomalies. The use of TAT feeding for nutritional support is an easy alternative to TPN. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-31.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-31.html Sun, 01 Apr 2012 00:00 am Neural tube defect with its global involvement of nervous system has lot of implications. There is cotroversy in terms of timing of repair, simultaneous or metachronous ventriculoperitoneal shunt and criteria for shunt surgery in neonatal age. We are reporting our approach and results of management of this disease in neonatal period. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-27.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-27.html Sun, 01 Apr 2012 00:00 am With modern prenatal imaging, liver cysts are being diagnosed more often. Although large cysts are usually asymptomatic, they may present as an abdominal emergency requiring surgery in the first weeks of life. We report a series of 3 patients with prenatal diagnosis of isolated cystic liver lesions diagnosed at 22, 31 and 33 weeks of gestational age. The hepatic origin of the cysts was confirmed prenatally by a MRI in 2 cases, with visualization of a normal gallbladder. The prenatal course was uneventful. Postnatal ultrasound confirmed the diagnosis of liver cyst, showed normality of the biliary tract and in one case, rupture of the cyst during delivery. Because of an uncommon rapid increase in size, the 3 children underwent surgical excision of the cysts within the first weeks of life. These were non-bile-containing intrahepatic cysts arising from segment IV. Long-term follow up was uneventful. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-36.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-36.html Sun, 01 Apr 2012 00:00 am Duodenal atresia has been reported in association with various malformations and syndromes common being Down syndrome, malrotation, and annular pancreas. Its association with multiple anomalies is rare and scarcely reported in literature. Herein 3 cases of duodenal atresia associated with multiple congenital anomalies are being reported. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-44.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-44.html Sun, 01 Apr 2012 00:00 am Debate http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-48.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-48.html Sun, 01 Apr 2012 00:00 am Necrotizing enterocolitis (NEC) is a common surgical emergency in neonates. The list of etiological agents of NEC is already exhaustive. A recent paper published in Pediatrics adds another factor to this long list [1]. Italian researchers have shown that Ranitidine could cause NEC in neonates. Although Ranitidine has not been approved by FDA for neonates, it is frequently used off-label to manage gastro-esophageal reflux and surgical stress. In fact, Athena used to prescribe it to all neonates, including NEC patients, who are kept nil per oral with an intent to prevent mucosal ulceration. Terrin et al have shown that Athena may be wrong in her approach. They evaluated 274 neonates with very low birth weight of 401 to 1500 g. Among them 91 had received Ranitidine and 183 had not. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-26.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-26.html Sun, 01 Apr 2012 00:00 am Megacystis Microcolon Intestinal Hypoperistalsis Syndrome is a quite rare congenital anomaly that presents with a functional obstruction of the gastrointestinal tract which is usually fatal. It is three to four times more prevalent in females. We present a case of a rare association of a male neonate with Megacystis Microcolon Intestinal Hypoperistalsis Syndrome who in addition had the classical triad of Prune Belly Syndrome and thus suggest a possibility of different spectrums with a common pathogenesis. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-30.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-30.html Sun, 01 Apr 2012 00:00 am A case of ileal atresia in association with duplication of terminal ileum is being reported here. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-33.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-33.html Sun, 01 Apr 2012 00:00 am A 3-day-old male child was brought to the hospital with complaints of abdominal distension and a mass in the upper abdomen causing respiratory difficulty. Child underwent exploratory laparotomy and a large multicystic mass arising from postero-inferior wall of the stomach along its greater curvature was excised and stomach repaired. On histopathology it came out mature gastric teratoma. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-34.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-34.html Sun, 01 Apr 2012 00:00 am A 25-day-old female baby having eventration of diaphragm associated with a big hiatal hernia is being reported here. This is the second report describing the rare association. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-41.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-41.html Sun, 01 Apr 2012 00:00 am Prenatal torsion of testis is an extremely rare surgical emergency with controversial management guidelines. Controversy exists not only with regard to timing and necessity of exploration but also whether or not to fix the contralateral testis as there is no predisposing anatomical defect. Though not life-threatening, it risks fertility of an otherwise healthy newborn male if overlooked. We describe a case of prenatal testicular torsion and discuss pertinent issues. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-37.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-37.html Sun, 01 Apr 2012 00:00 am A congenital epulis is a rare benign jaw tumor of neonate and is also known as “congenital gingival granular cell tumor”. The Greek word ‘‘epulis’’ means ‘‘swelling of the gingiva’’. It was first described in 1871 by Neumann; hence the alternative name is Neumann’s Tumor. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-28.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-28.html Sun, 01 Apr 2012 00:00 am Congenital pyloric atresia is a rare anomaly accounting for less than 1% of upper GI atresias. It may occur in isolation or in association with other congenital anomalies, epidermolysis bullosa being the most frequent. It presents with upper abdominal distension, non-bilious vomiting or rarely with complications as aspiration pneumonia, electrolyte imbalance or gastric perforation. Though iatrogenic gastric perforations secondary to aggressive resuscitation with bag-mask ventilation and nasogastric intubation are the most frequent in newborns, neonatal gastric perforation due to congenital outlet obstruction have rarely been reported. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-24.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-124.html Sun, 01 Apr 2012 00:00 am Intestinal atresia is fourth common cause of neonatal intestinal obstruction [1]. Colonic atresia is relatively rare with an incidence of 1:40,000 to 1:60,000 live births. Coexisting jejunoileal and colonic atresias are scarcely described in literature. http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-43.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-43.html Sun, 01 Apr 2012 00:00 am Face the Examiner http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-29.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-1-29.html Sun, 01 Apr 2012 00:00 am A 15 days old male newborn presented with four exophytic swellings arising from the skin of right lower limb; not restricting its mobility (Fig.1). The lesions were sequentially excised and pathological examination revealed infantile myofibromatosis in these growths. No evidence of malignancy was found (Fig.2). The swelling in the thigh recurred after 6 months and suspecting sarcomatous change, a biopsy was done which confirmed the sarcomatous change. Amputation and chemotherapy was offered, and the poor response to chemo-radiotherapy was explained. Parents refused further treatment and child succumbed to the disease after developing inguinal nodes and visceral metastasis. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-21.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-21.html Sun, 01 jan 2012 00:00 am The prognosis and outcome of surgical neonates travelled across many phases of development of modern sciences. In past the prognosis of surgical conditions, as whole regardless of the age, was poor. But with the advent of modern anesthesia and intensive care units and involvement of new diagnostic and therapeutic modalities the prognosis is now on the move. Contrarily, surgical neonates are a subclass of patients having wide differences in physiology, anatomy, diseases, immunity and response to the stress, as compared to older patients. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-23.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-23.html Sun, 01 jan 2012 00:00 am The dream of Dr. M. Bilal Mirza became a reality on 17th July 2011 when his surreal idea of starting a new online Journal of Neonatal Surgery was endorsed by us. And now in less than six months, on the occasion of the New Year of 2012, with the concerted help and support of learned colleagues, we deliver the first issue of the Journal of Neonatal Surgery. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-1.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-1.html Sun, 01 jan 2012 00:00 am Background: To assess the prognosis of surgical neonates at admission and the factors responsible for mortality in neonates. Material and Methods: A prospective study was conducted in a tertiary level hospital over 15 months and various clinical and biochemical parameters were collected and analyzed using STATA® and SPSS®. Results: On multivariate analysis of 165 neonates, early gestational age, respiratory distress and shock at presentation were the factors of poor prognosis in neonates. The factors could be related to poor antenatal care and sepsis acquired before transfer of the baby to the nursery. Conclusion: The improvement in antenatal care and asepsis during transfer and handling the babies is of utmost importance to improve the prognosis of surgical neonates. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-20.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-20.html Sun, 01 jan 2012 00:00 am Background: Colonic atresia and stenosis are rare entities. On average 1 case per year of colonic atresia is being seen in most of pediatric surgical centers and to date less than 10 cases of colonic stenosis have been reported. Material and Methods: The medical record of patients of colonic atresia and stenosis managed during March 2006 to March 2010 was reviewed. Results: A total of 15 patients of colonic atresia (11) and stenosis (4) were the study population. Four were ascending colon atresia, 2 at hepatic flexure and transverse colon each, and 1 at sigmoid colon. Two patients had multiple colonic atresias. One patient of ascending colon atresia also had pyloric atresia. In colonic stenosis population (two congenital and two secondary to necrotizing enterocolitis), two were transverse colon stenosis and two were sigmoid colon stenosis. The preoperative diagnosis was distal small bowel atresia in 11 patients. Colonic atresias were managed by colocolic anastomosis with covering ileostomy in 8 patients. The remaining 3 patients were managed by exteriorizing both ends of atresia. Colonic stenosis cases were managed by primary colocolic anastomosis in 1 patient and colocolic anastomosis under covering ileostomy in 3 patients. Three patients of colonic atresia succumbed postoperatively. Conclusion: Colonic atresia and stenosis are rare entities. Associated alimentary tract malformations may result poor prognosis. Colonic atresia can safely be managed by colocolic anastomosis with covering ileostomy. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-12.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-12.html Sun, 01 jan 2012 00:00 am Background: To audit the demographics, outcome and factors affecting long-term survival in infants and neonates with solid tumors. Material and Methods: Retrospective case series was performed for 13 years. Demographics, surgical notes, treatment protocols and outcome details were reviewed. Results: Of total 372 tumors over 13 years, there were 59 infants (15.86%) of which 8 were neonates, with M:F 1.2:1, and mean age of presentation was 5.18months. Fifty three of the infants had tumors which were > 5 cm in size. Thirty two (54%) had a rapid progression of the lesion during investigations. Tumors markers and pre-operative biopsy were diagnostic in 61.5% and 30% respectively. Neuroblastoma was the commonest tumor (22%), followed by hepatoblastoma (20.3%), malignant germ cell tumor (20.3%), soft tissue sarcomas (11.9%), and others (8.5%). Staging distribution for 39 (66%) infants showed Stage 1-n=9, Stage 2-n=15, Stage 3-n=7, Stage 4-n= 5 and Stage IVs-n=3. Nineteen (32.2%) babies received chemotherapy. Almost half (50.8%) of the children underwent surgical removal of the tumor; with gross total resection in 76.6%. The overall mortality was 35.6%. About 30.5% are alive, well and tumor free on 2-12 years follow-up. Conclusion: A much higher incidence (15.8%) of infantile tumors in our region as compared to literature (2%) is alarming. Treatment failures from deaths or non-compliance amounted to be 69.5%. These are the two major issues which need to be addressed in the future management of infantile tumors. Reduction in deaths due to chemotherapy toxicity, rapid surgical intervention and R0 resection and risk stratification needs to be incorporated, to improve long-term tumor free survival in infants. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-3.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-3.html Sun, 01 jan 2012 00:00 am Pyloric atresia is rare cause of gastrointestinal obstruction in neonates and usually occurs as an isolated anomaly. They have been associated with multiple small bowel and colonic atresias but not reported in association with isolated multiple colonic atresias. A case of pyloric atresia oc-curring in association with multiple colonic atresias is being reported here. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-2.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-2.html Sun, 01 jan 2012 00:00 am We are presenting two cases of Sirenomelia (Mermaid Syndrome), which is an extreme example of the caudal regression syndrome. It invariably presents with lower limb fusion, sacral and pelvic bony anomalies, absent external genitalia, imperforate anus, and renal agenesis or dysgenesis. There are approximately 300 cases reported in the literature, 15% of which are associated with twinning, most often monozygotic. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation. One of our cases survived for 12 days after birth. This new born had an unusually high anorectal anomaly in which the colon was ending at the level of mid transverse colon, fused lower limbs and genital anomalies. Ultrasound of the abdomen revealed horseshoe kidney. Colostomy was performed on day 2 of life. The second case encountered was a stillborn baby on whom an autopsy was performed. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-4.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-4.html Sun, 01 jan 2012 00:00 am Aplasia cutis congenita is a rare congenital anomaly characterized by the absence of a patch of skin since birth. It may lead to life threatening complications at times. A 5-day-old neonate with Aplasia cutis congenita was received in a state of shock due to tremendous blood loss from the superior sagittal sinus. The neonate was resuscitated immediately followed by closure of the superior sagittal sinus and flap coverage to the defect as a life saving procedure. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-17.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-17.html Sun, 01 jan 2012 00:00 am A case of sirenomelia is being reported who was born in a twin pregnancy and showed different anatomy of lower torso. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-16.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-16.html Sun, 01 jan 2012 00:00 am Appendicitis is the most common cause of acute sur­gical abdomen in children and adults but very rare in infants and neonates. Nonspecific clinical features and low index of suspicion make its diagnosis and man­agement challenging which may result in high chances of complications like perforation and peritonitis thus increasing the morbidity and mortality. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-14.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-14.html Sun, 01 jan 2012 00:00 am Meckel’s diverticulum was first described in 1598 by Hildanus. Meckel’s diverticulum is said to be present in 2 % of population. It is twice as common in males as opposed to females. Most of the symptomatic cases present within the first 2 years of life. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-15.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-15.html Sun, 01 jan 2012 00:00 am Hypothermia in surgical neonates is associated with serious implications and during surgery may lead to the damage to various organs of body and therefore affects the ultimate outcome. Neonatal hypothermia affects the vital organ’s circulation such as cerebral, myocardial and renal and these organs are more sensitive to resultant ischemia. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-5.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-5.html Sun, 01 jan 2012 00:00 am Ever since the humans have evolved the evolution is not limited to physical aspect of life but also to the world surrounding it. As man started to cope up with the chal­lenges of life he learnt new ways and methods. These ways opened doors to a whole new dimension of life- the research. Practice led to strange new discoveries and eventually the implementation of these moved us into better understanding. Technology, science, health and various other disciplines of life started to grow. With the advent of the 20th century mankind stepped into a whole new space, the “cyber space”. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-18.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-18.html Sun, 01 jan 2012 00:00 am With improvements in healthcare, the survival of preterm babies has increased significantly and these preterm and ex-preterm babies often present for various surgical interventions. Previously, it was believed that due to the immaturity of the nervous system, these preterm babies do not experience or feel pain and consequently inadequate or no anaesthesia was administered to them. Recent work has shown that as early as the 13th to 20th week of gestation, there is perception of pain. Evoked potentials and cerebral glucose metabolism offer evidence of functional maturity and responses such as changes in pulse and blood pressure, crying, and grimacing have been quantified for circumcisions done without anaesthesia. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-25.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-25.html Sun, 01 jan 2012 00:00 am Arguably, release of tongue tie is the oldest surgical procedure and it is perhaps older than circumcision. According to the Old Testament, the Lord released the tied tongue of Moses and made him speak well. Tongue-tie is pedantically known as ankyloglossia inferior minor. Simplicity of its treatment has earned this malady several etiological attributions such as difficulty of speech and breast feeding. All over the world, lactation consultants refer neonates for release of tongue tie as they believe it to be the cause of maternal nipple pain.Perhaps this is the only indication of tongue tie release in neonates. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-19.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-19.html Sun, 01 jan 2012 00:00 am Ten questions are asked about esophageal atresia with/without tracheo-esophageal fistula. http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-9.html http://www.jneonatalsurg.com/documents/vol-1/html/jns-2012-1-9.html Sun, 01 jan 2012 00:00 am A 3-day-old male baby was diagnosed to have proximal small bowel atresia. At operation type-IIIa jejuno-ileal atresia (JIA) was encountered with a jumbled up sequestered bowel-loop-mass. The jejunum was 10 cm and ileum merely 1 cm. The bowel was sequestered on account of volvulus in-utero.