ABSTRACT
This chapter discusses the surgical issues commonly seen in the neonatal period, providing an insight into their causes and clinical presentation. The timing and mode of delivery should be a joint decision between the obstetrician, the neonatal team and the surgeon. Although many conditions are managed with a natural birth, occasionally a caesarean section might be safer with an anomaly such as gross hydrocephalus. Intestinal obstruction and/or sepsis predispose the infant to increased gastric secretions which may consist of bile, gastric juices or blood. Surgery can exacerbate physiological imbalances in the newborn. It is essential, therefore, to continuously assess and monitor perfusion, parenteral fluid and electrolyte requirements, and metabolic response to surgical trauma. Signs of obstruction include bile-stained vomiting, abdominal distension, large gastric aspirates, and delay or failure to pass meconium. Jejuno-ileal and colonic atresias are thought to be due to a localised intrauterine vascular accident with ischaemic necrosis of the bowel and subsequent reabsorption of the affected segment.
