Neonatal surgery: fixing congenital abnormalities

Written by: Mr Stefano Giuliani
Published:
Edited by: Bronwen Griffiths

Newborns need surgery when they are born with congenital abnormalities. This means that some organs did not form in the right way before birth and there is a need to perform neonatal surgery to correct the anatomy to allow that organ to function properly. Mr Stefano Giuliani, an expert neonatal surgeon, explains why some newborn babies require surgery after birth.

What are the most common reasons a newborn might need surgery?

The most common conditions requiring surgery in the neonatal period are:

  • Oesophageal atresia (the upper part of the oesophagus connects to a small pouch instead of the lower oesophagus and stomach)
  • Congenital diaphragmatic hernia (failure of the diaphragm muscle to close during development, causing contents from the abdomen to move up into the chest cavity)
  • Gastroschisis (abnormality of the abdominal wall in which the intestines are found outside the baby’s body)
  • Omphalocele (a hole in the belly button causes abdominal organs to end up outside their body)
  • Imperforate anus (the opening of the anus is missing or blocked)
  • Hirschsprung’s disease (an intestinal blockage caused by the lack of movements in the last portion of the bowel)
  • Intestinal atresia (blockage or obstruction in the intestine)
  • Intestinal perforation (a hole or rupture in the intestines)
  • Inguinal hernia (when abdominal organs come through the inguinal ring in the groin due to its failure to close properly during development)
  • Hypertrophic pyloric stenosis (the acquired thickening of the valve at the end of the stomach causing projectile vomiting)

What are the risk factors? Are premature babies more likely to need surgery?

In general, consanguinity (blood relation) is the main risk factor for congenital abnormalities. This happens when the mother and father are related. Other risk factors, such as smoking and drug use during pregnancy, are associated with gastroschisis. Premature babies are at risk of developing an acute inflammation of their intestine (necrotising enterocolitis) that can require an operation, and, they also have a high incidence of inguinal hernias.

Is surgery always an emergency, or is it sometimes better to wait?

Surgery is not always an emergency. There are congenital abnormalities that require an operation within the first 24 hours of life (oesophageal atresia, gastroschisis, intestinal atresia etc.). For other conditions, it is possible to wait and see if the baby can get better without an operation (i.e. early stage necrotising enterocolitis).

Can any procedures be carried out before birth?

There are exciting advances in the field of foetal surgery. It is now possible to help babies affected by congenital diaphragmatic hernias by placing a small balloon in their windpipe when they are still in the womb. This balloon helps the lungs to develop and to function better after birth. Other common prenatal interventions are: drainage of abdominal and thoracic cysts, ligation of abnormal blood vessels and amniotic bands.

By Mr Stefano Giuliani
Paediatric surgery

Mr Stefano Giuliani is one of London's leading paediatric surgeons working at Great Ormond Street Hospital for Children. He is an expert in neonatal, gastrointestinal, oncologic and minimally invasive surgery for children.

Mr Giuliani qualified as a specialist Paediatric surgeon in 2006 at the University of Padova, Italy. Then he worked for four years with world-renowned surgeons at the Children's Hospital Los Angeles (USA) achieving excellent skills in the most complex cases in the field of Paediatric Surgery. Mr Giuliani has been a consultant paediatric surgeon since 2008 and he moved to London in 2011. Currently working across prestigious hospitals in Central London, including Great Ormond Street Hospital for Sick Children, The Portland Hospital for Women and Children and The Harley Street Clinic.

Mr Giuliani has a license to practice in the UK, Italy, and the USA. This international background makes him an experienced paediatric surgeon aware of the latest and most advanced minimally invasive surgical techniques (laparoscopy and thoracoscopy) in the field. 

Mr Giuliani holds a PhD in Developmental Biology and he is Honorary Senior Lecturer at University College London (UCL). He directs a successful research team aiming to advance the field of Neonatal and Paediatric surgery. He has published extensively in famous international peer-reviewed journals and presented his research at international meetings all around the world.

View Profile

Overall assessment of their patients


This website uses its own and third-party cookies to collect information in order to improve our services, to show you advertising related to your preferences, as well as to analyse your browsing habits..