Neonatal surgery has reached a high degree of sophistication. Anomalies that were highly lethal in the 1950s and 1960s are now expected to yield nearly 100% survival. This achievement is based not only on “maturation” of the techniques of repairs but more so on refinement of neonatal care in general (e.g., anesthesia, neonatology, and radiology) and concomitant deeper understanding of neonates' physiology and special needs. We are now entering a new era of widespread screening of the unborn by means of ultrasound, with planned intrauterine, intrapartum, and immediate postpartum interventions.

In general, pediatric surgeons now believe that early (neonatal) correction of many of the anomalies will achieve better long-term functional results and, in many instances, will shorten total hospitalization time, reduce number of admissions, and minimize the psychologic stresses to the baby and family. The advent of rapid computed tomography (CT) scanning, magnetic resonance (MR) imaging, and refined ultrasound have eliminated most diagnostic errors so that carefully planned operations can be carried out to an ultimate success.

Many pediatric surgical centers are now focusing their investigative efforts on elucidating the cellular, molecular, and biochemical response to disease and therapeutic agents. Nitric oxide (NO) is a more recent such example whose influence on the functions of smooth muscles in various organ systems is being worked out (initially investigated and used for pulmonary arteriolar dilation on babies with congenital diaphragmatic hernia [CDH] or persisting fetal circulation but is looked at for a range of other conditions). Liquid ventilation, using perflurocarbon medium, was successful in laboratory testing in various pulmonary failure syndromes and is now entering clinical trials. The discovery and isolation of tumor angiogenic factor contribute to the understanding of tumor growth and the potential for antiangiogenic therapy. In the operative sphere, newly developed instruments and their applications to pediatric care, especially minimally invasive endoscopic procedures (laparoscopy and thoracoscopy) are now used in most pediatric surgical care centers with ever-increasing frequency and for a variety of conditions.

Since the topic of neonatal surgery is so wide and encompassing, I will limit the presentation to some of the newer applications, techniques, and approaches that were entered into our discipline.