Babies with critical illnesses may require surgery within the first few days or weeks of life. At Children’s Hospital Los Angeles, your baby’s safety is our top priority. Our neonatal surgeons are experts who perform even the most complex procedures that other centers can’t.
Neonatologists in the Fetal and Neonatal Institute collaborate closely with the Department of Surgery and Department of Critical Care Medicine and Anesthesiology. If a baby’s condition is so severe that movement poses risks, the surgical team can operate in the Newborn and Infant Critical Care Unit (NICCU).
We provide surgical treatment for a range of infant and neonatal conditions, including:
- Abdominal wall defects
- Bowel atresia
- Cleft lip and palate
- Congenital diaphragmatic hernia
- Esophageal atresia
- Tracheoesophageal fistula
- Vascular malformations
In the early stages of normal fetal development, organs including the stomach or intestines grow outside the abdomen. As a fetus grows, the organs move inside the abdomen. Sometimes, the abdomen doesn’t close fully around these organs. When this occurs, we call it an abdominal wall defect.
Our program performs a high volume of surgeries to repair abdominal wall defects. Our surgeons treat about 25-30 babies each year with these conditions.
We provide treatment for the two main types of abdominal wall defects:
- Gastroschisis. Gastroschisis occurs when the organs protrude through a hole near the belly button. In severe cases, the liver may also push outside the body.
- Omphalocele. In omphalocele, the organs also protrude through the belly button. A thin membrane or sac covers the organs. Usually, babies born with omphalocele also have additional genetic abnormalities or conditions.
Babies with bowel atresia are born with an intestinal blockage. Often, we use fetal imaging to diagnose this condition before birth. Babies with intestinal blockages may have surgery immediately after birth.
Before surgery, we stabilize the baby by placing a nasogastric (NG) tube in the nose. This tube uses gentle suction to keep the stomach empty. We also place an intravenous (IV) line so that babies can get nutrition and stay hydrated.
Babies with congenital diaphragmatic hernia (CDH) are born with an opening in the diaphragm (the horizontal muscle that separates the chest from the abdomen). When this muscle is open, the stomach and intestines may move into the chest, impacting lung function and growth.
At CHLA, our experts care for about 20% of all babies with CDH in the state. We have treated hundreds of babies with this condition with excellent results.
Often, we can identify CDH before a baby is born with advanced fetal imaging techniques. This allows us to prepare for supporting your baby upon birth, including providing assistance with breathing.
Babies with CDH may need help with breathing, blood pressure and cardiac support, which may include extracorporeal membrane oxygenation (ECMO). We may also operate immediately after your baby is born.
Surgical repair of CDH
Immediately after birth, our first priority is stabilizing your baby. We connect babies to a tube and ventilator to assist with breathing. If this ventilation method doesn’t help, we may use extracorporeal membrane oxygenation (ECMO). ECMO takes over and does the work of the heart and lungs, allowing your baby’s lungs to rest.
Esophageal atresia (EA) is a condition that affects a baby’s swallowing tube (esophagus). The esophagus aids in passing food from the mouth to the stomach. In esophageal atresia, part of the swallowing tube does not develop properly. Babies with the condition cannot pass food to the stomach and may have trouble breathing.
Tracheoesophageal fistula (TEF) is an abnormal connection between the esophagus and trachea. Babies with TEF can still swallow, but food or breastmilk may leak through the fistula into their lungs. The hole must be closed so that the baby can eat normally.