Impact of prenatal diagnosis on neonatal surgery

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Prenatal ultrasound diagnosis has radically altered neonatal surgical practice. Advance warning of severe structural malformations allows time for detailed parental counselling by neonatal surgeons in conjunction with obstetricians and neonatologists, so that the parents of an infant with an abnormality may be adequately prepared for the investigations and surgery which will be required after birth. Prenatal diagnosis also creates opportunities for interventions during pregnancy such as fetal karyotyping, in-utero transfer and planned delivery in a perinatal centre where neonatal surgical and anaesthetic expertise is readily available. Selective termination of fetuses found to have chromosomal abnormalities or such severe abnormalities that survival is unlikely, results in relatively ‘good-risk’ populations presenting to neonatal surgeons after birth. Consequently, survival rates after surgery have improved in many conditions. Neonatal surgeons should be informed of any prenatal diagnosis of a surgical abnormality and should be actively involved in parental counselling and perinatal management. Prenatal ultrasound diagnosis has radically altered neonatal surgical practice. Advance warning of severe structural malformations allows time for detailed parental counselling by neonatal surgeons in conjunction with obstetricians and neonatologists, so that the parents of an infant with an abnormality may be adequately prepared for the investigations and surgery which will be required after birth. Prenatal diagnosis also creates opportunities for interventions during pregnancy such as fetal karyotyping, in-utero transfer and planned delivery in a perinatal centre where neonatal surgical and anaesthetic expertise is readily available. Selective termination of fetuses found to have chromosomal abnormalities or such severe abnormalities that survival is unlikely, results in relatively ‘good-risk’ populations presenting to neonatal surgeons after birth. Consequently, survival rates after surgery have improved in many conditions. Neonatal surgeons should be informed of any prenatal diagnosis of a surgical abnormality and should be actively involved in parental counselling and perinatal management.