Neonatal surgical problems of the chest

Neonatal surgical problems of the chest include a wide spectrum of anomalies that extend from chest wall deformities to developmental cardiac malformations. Many chest conditions have other associated anomalies such as chromosomal anomalies that may form part of more complex syndromes. In the era before prenatal diagnosis many of these conditions would present as fetal loss or asymptomatically and discovered incidentally during postnatal imaging. Prenatal diagnosis has revolutionised the diagnosis and treatment of these conditions. Congenital lung lesions have a prenatal diagnostic accuracy of almost 100% and are mainly asymptomatic at postnatal presentation. The diagnosis may be confirmed on postnatal computerised tomography (CT) scan, however the treatment of these asymptomatic lesions remain controversial. Most institutions offer surgery however surveillance with CT imaging is the alternate management. Chylothorax and thoracic teratoma are other thoracic conditions discussed. More than 60% of cases that are prenatally diagnosed with congenital diaphragmatic hernia, do not make it beyond the neonatal period. Complex associated anomalies and lung hypoplasia are the prime causative factors for this grim outcome. Even those infants that survive post surgical repair, some will have respiratory, gastrointestinal or neurological sequeli. Diagnosis of oesophageal atresia is less accurate on prenatal scan. Surgery could be challenging and outcomes are dependent on associated anomalies. © 2009 Elsevier Ltd. All rights reserved.