Neonatal abdominal conditions: a review of current practice and emerging trends

In the UK, NHS maternity statistics show that the number of preterm deliveries is increasing. Premature neonates have an increased incidence of congenital anomalies and these are an independent risk factor for a premature birth. Therefore, the population of neonates with gestational prematurity and congenital anomalies requiring the attention of a surgeon is rising. Many conditions affecting neonates (e.g. gastroschisis) can now be diagnosed antenatally with ultrasound. Defects of the abdominal wall are obvious at birth. Babies with intestinal obstruction will present with the four cardinal signs: vomiting, abdominal distension, pain and constipation. Abdominal X-Ray and contrast studies are useful studies in identifying the cause and level of obstruction. In the UK, neonatal surgery is carried out by specialist paediatric surgeons in a few tertiary referral centres. The timing of transfer is a key consideration in managing neonates with surgical conditions. This article reviews current practice and emerging trends in the management of several neonatal abdominal conditions that continue to provide a challenge to paediatric surgeons.