Neonatal Surgery

Neonatal surgery addresses conditions that are a consequence of abnormal development in utero or that occur shortly after birth. These procedures are performed as needed after babies are born and can be minimally invasive or open, depending on the condition.

• Anorectal malformations
• Congenital diaphragmatic hernia
• Esophageal atresia/Tracheoesophageal fistula
• Gastroschisis
• Heart defects
• Hirschsprung’s disease
• Intestinal blockages
• Lung lesions and tumors
• Necrotizing enterocolitis
• Omphalocele
• Short bowel syndrome

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Conditions we treat:

Anorectal malformations: Learn more

Bowel obstruction/Small bowel atresia: Small bowel atresia affects the small intestine and is classified as either atresia (a complete blockage or lack of continuity in the bowel) or stenosis (a partial obstruction that restricts the bowel). Surgical repair of a small bowel atresia is typically performed during the first few days of life, once a baby has been stabilized.

Congenital diaphragmatic hernia (CDH):

In healthy people, the diaphragm separates abdominal organs (for example, the stomach and intestines) from those in the chest (the lungs and heart). However, for some infants, the diaphragm develops abnormally during gestation resulting in holes that allow the abdominal organs to move into the chest cavity. This is called a congenital diaphragm hernia. The abdominal organs now occupying the chest area can crowd the lungs and result in their underdevelopment (pulmonary hypoplasia), which causes difficulty breathing once the baby is born. CDH can be diagnosed prenatally using ultrasounds but may also be diagnosed after birth if the baby is having trouble breathing.

Congenital diaphragmatic hernias can vary in severity. The most significant indicator of CDH severity is the location of the liver; if the liver is found in the chest cavity, the more severe the child’s pulmonary hypoplasia is likely to be. A more detailed measurement of pulmonary hypoplasia severity can be determined by looking at a baby’s lung area to head circumference ratio, and then comparing that ratio to what can be expected in a healthy baby.

Once a baby has been diagnosed with CDH, a team including maternal-fetal medicine specialists and pediatric surgeons will work with the pregnant person to develop a treatment and delivery plan. After delivery, your baby will be placed in the Newborn Intensive Care Unit (NICU), where physicians and specialists will be waiting to stabilize the baby and provide breathing assistance through ventilators. In severe cases of CDH, our physicians will place the baby on extracorporeal membrane oxygenation (ECMO), which takes over the functions of the heart and lungs, allowing those organs to rest.

Eventually, when the lungs become less vulnerable, a pediatric surgeon will repair the congenital diaphragmatic hernia by making a small incision below the baby’s rib cage, guiding the appropriate organs back down into the abdomen, and then closing the hole in the diaphragm. In some cases, if a there is a large defect or if a baby is lacking a diaphragm, the surgeon will use a patch or muscle flap to close the hole.

Esophageal atresia/Tracheoesophageal fistula: Learn more

Gastroschisis: Gastroschisis is a congenital condition caused by a hole in the abdominal wall next to the belly button. This hole, which can vary in size, allows the baby’s intestines to extend outside of their body. Sometimes, other organs like the stomach and liver can also be found outside the body. Once the baby is born, a surgeon will place the organs back inside the belly and close the opening.

Heart Defects: Congenital heart defects are the most common type of birth defect. There are a wide range of types of heart defects of varying severities, but in general they impact blood flow through the heart, lungs and body. They can often be diagnosed during pregnancy. Because of the diversity and complexity of heart defects, treatments are based on the individual condition. In some cases, the defects may resolve themselves as the child grows, while others will be managed with medications and surgery.

Hirschsprung’s disease: Learn more

Lung lesions and tumors: Learn more

Necrotizing enterocolitis (NEC): Necrotizing enterocolitis typically affects premature infants. The specific causes of the disease are unknown, but the result is an invasion of the intestinal wall by bacteria leading to infection and inflammation. As the infection progresses, the intestinal tissue can die, leading to a perforation in the intestine and the risk of stool spilling into the abdomen. In cases of severe NEC that include dead tissue or perforation, surgery may be required to remove the damaged tissue. In some situations, a surgeon may also recommend a temporary ostomy, which can aid in the baby’s recovery from the infection alongside additional treatments[LKW(1] . In these cases, a surgeon will resect the bowel and create colostomy/ileostomy, followed by a subsequent closure

Omphalocele: An omphalocele is a birth defect in which an infant’s intestines and possibly other organs stick outside the belly through the belly button. A thin, transparent sac covers the organs. Treatment for omphaloceles depends on the size of the herniation; small omphaloceles include only bowel, while large or giant omphaloceles contain the liver and other abdominal organs. The treatment of an omphalocele is all dependent on its size and the baby’s pulmonary status. Small omphaloceles can be treated surgically with a primary repair. Larger omphaloceles can be surgically treated using a staged repair or a “paint and wait” technique depending on respiratory status.

• Primary Repair: A primary repair can be used to treat small omphaloceles. In this procedure, usually a couple days after a baby’s birth, a surgeon will push the intestine back into the abdomen then close the muscle and skin. In cases where the abdomen is small and the muscle can’t be sewn together, the hole will be covered with Gore-Tex with the skin closed over it.
• Staged Repair/Schuster procedure: For larger omphaloceles, especially those that include additional organs like the liver, a gradual process is needed. This allows the abdominal wall to stretch to accommodate the organs while ensuring the lungs can continue to grow without being crowded. During a staged repair, a covering is placed over the omphalocele and gently pushes the contents back into the abdomen over a period of days or weeks.
• “Paint and Wait:” In some cases, such as when the omphalocele is very large and the baby’s abdomen is very small, pushing the organs back into the abdomen may be too risky. In those situations, doctors can use a more extended “paint and wait” strategy. In this process, the sac is “painted” with antibiotic cream and slowly over time, the baby’s skin grows to cover the sac. Eventually, the sac will be wrapped in bandages that will then slowly push the sac back into the abdomen.

Short bowel syndrome: Short bowel syndrome happens when part of the small intestine is missing or malfunctioning, resulting in an inability to absorb enough fluids and nutrients. In babies, short bowel syndrome can occur if the infant is born with a short small intestine or with a damaged small intestine that must be surgically removed.