NEONATAL SURGERY - 1976

Introduction

   An analysis of The Structure of early infant mortality demonstrates that the primary causes of death in newborns are asphyxia of various origins, Congenital Malformations, Pneumonia, and purulent-Inflammatory Diseases (A. F. Tur, 1967; our data, et al.).

Successful Treatment of most of these conditions is possible only through well-organized management and the availability of specially trained pediatricians, specialists in pediatric anesthesia and intensive care, surgeons, radiologists, and nurses, alongside proper equipment, instrumentation, and other resources.

This manual is based on 15 years of experience at the Center for Neonatal Surgery of the Department of Pediatric Surgery at the Central Order of Lenin Institute for Advanced Medical Training (HEAD of the Department: Prof. S. Ya. Doletsky; Institute Rector: M. D. Kovrigina), operating at the No. 2 Rusakov Children's Clinical Hospital (Chief Medical Officer: M. I. Malyavina).

An analysis of medical histories of over 300 newborns with surgical conditions and congenital malformations, supported by data from foreign pediatric surgeons (Mustard et al., 1969; Rickham, 1969), demonstrates that neonatal surgery is primarily the surgery of Congenital malformations and purulent-inflammatory conditions. More than 2% of all newborns have developmental anomalies that require surgical correction. Only timely, skillfully performed surgery can save their lives or ensure their normal future development.

According to World Health Organization data based on the results of 24 specialized centers across 16 countries, the proportion of children born with congenital malformations has shown no downward trend in recent years. The majority of purulent-inflammatory diseases in newborns also require surgical intervention. Improving treatment outcomes for these patient populations is a critical task for the pediatric healthcare service and will contribute to a further reduction in early infant mortality in our country.

Neonatal surgery is one of the youngest and most rapidly developing fields in pediatric surgery. It was only at the beginning of this century that the first isolated reports of successful surgical interventions in infants during their first days and weeks of life were published. The first neonatal surgery centers in our country were established in 1959–1960 in Moscow and Leningrad (S. D. Ternovsky, S. Ya. Doletsky, G. A. Bairov, et al.). Major contributions to The Development of neonatal surgery were made by Duhamel (France), Grob (Switzerland), Browne, Forschall, Rickham (England), Gross, Swenson (USA), A. P. Biezins, Yu. F. Isakov (USSR), and others.

This manual on neonatal surgery is intended primarily for pediatric surgeons, neonatologists and pediatricians in maternity hospitals and infant care units, as well as specialists in related fields (pediatric anesthesiologists and intensivists, pediatric radiologists, etc.). These are the practitioners who are first to encounter newborns in need of surgical care in their daily practice, and upon whose knowledge depend the timely, accurate Diagnosis and the future well-being of the young patient.

Accordingly, special emphasis is placed on describing diagnostic and surgical-technical approaches that have been successfully applied in neonatal surgery centers for many years but have not yet become widespread in general clinical practice.

One of the most complex challenges facing practitioners caring for newborns with congenital malformations is understanding the relationship between normal Embryogenesis and its deviations at various stages of Embryonic and Fetal development. The authors of this book have sought to bridge the gap between classical Embryology and the clinical variants, anomalies, and malformations encountered in practice by including embryological illustrations depicting normal and pathological stages of fetal formation. The hypothetical concepts regarding the development of organ malformations represent a systematic compilation and expansion of the works of domestic and foreign embryologists and surgeons.

The anatomical and embryological sections were compiled by V. G. Hakobyan, MD, who also created the original illustrations for the book.

The manual examines the anatomical and PHYSIOLOGICAL CHARACTERISTICS OF the newborn infant, addressing topics such as the organization of neonatal surgical care, the Selection of optimal timing for surgical intervention in various congenital malformations, and medical deontological issues in neonatal surgery.

Particular attention is paid to modern principles of preoperative preparation, neonatal anesthesia, and postoperative patient management. A dedicated section covers the vital role of the ward nurse in the nursing care and recovery of the newborn.

The specialized sections examine the nuances of surgical technique in neonatal surgery and describe the Procedures for common operations. Significant space is devoted to clinical manifestations, diagnostic and differential diagnostic criteria, and indications for surgical and conservative treatment of Malformations of the head, face, neck, chest cavity and Organs, abdominal wall and organs, Urogenital System, Vascular System, and Bones and joints. Diagnosis and management of neonatal purulent-inflammatory diseases, Sepsis, trauma, tumors, and other conditions are also detailed.

Staff members of the Department of Pediatric Surgery and the Pediatric Surgery Division of the Central Research Laboratory at the Central Institute for Advanced Medical Training participated in the preparation of this manual. Specific chapters were authored by Prof. B. A. Konstantinov, Prof. L. A. Durnov, and Prof. E. S. Bondarenko.

The authors will be grateful for any critical feedback and suggestions aimed at improving this manual.