Meconium Plug Research Articles

Neonatal meconium-related obstruction: Establishing a research strategy to evaluate an evolving disease

PurposeThe link between prematurity and meconium-related obstruction is understudied. We sought to describe the contemporary spectrum of meconium-related obstruction and to validate the use of ICD-10 codes for the study of this family of diseases. MethodsThis retrospective cohort study included neonates within our health system treated for a radiographically or intraoperatively confirmed meconium-related obstruction from January 2018 to December 2022. We stratified obstructions by type (meconium ileus vs meconium plug syndrome) and need for intervention (contrast enema vs surgery). We evaluated the association of prematurity, cystic fibrosis, and Hirschsprung's disease with disease severity using t-tests, ANOVA, and chi-squared tests. We secondarily evaluated the accuracy of ICD-10 codes at identifying meconium-related obstructions using sensitivity, specificity, and predictive values. ResultsOver five years, 18 infants were treated for meconium-related obstruction. This included five patients (28%) with meconium ileus and 13 (72%) with meconium plug syndrome. Twelve neonates (67%) were preterm, including all five (100%) treated for meconium ileus, none of whom had cystic fibrosis or Hirschsprung's disease. Among infants with meconium plug syndrome, one (8%) had cystic fibrosis and two (15%) had Hirschsprung's disease. Eight (44%) patients required a contrast enema, 5 (28%) multiple contrast enemas, and 5 (28%) surgery. Increasing prematurity was associated with worse disease severity (p<0.001). Diagnosis code P76.0 identified all cases of meconium-related obstruction (sensitivity=100%; specificity=95%). ConclusionsMost meconium-related obstructions were related to prematurity and not cystic fibrosis or Hirschsprung's disease. The use of ICD-10 code P76.0 is a promising research strategy for this evolving condition. Level of evidenceLevel III – retrospective comparative study

Investigations, management and outcome of neonates presenting with distal intestinal obstruction: challenging the need for contrast enemas

PurposeTo characterise the investigations, management and ultimate diagnosis of neonates with distal intestinal obstruction.MethodsRetrospective review of term (> 37 weeks) neonates with admission diagnosis of distal intestinal obstruction over 10 years (2012–2022). Patient pathways were identified and associations between presentations, response to treatments and outcome investigated.ResultsA total of 124 neonates were identified and all included. Initial management was colonic irrigation in 108, contrast enema in 4, and laparotomy in 12. Of those responding to irrigations none underwent contrast enema. Ultimately, 22 neonates proceeded to laparotomy. Overall, 106 had a suction rectal biopsy and 41 had genetic testing for cystic fibrosis. Final diagnosis was Hirschsprung disease (HD) in 67, meconium ileus with cystic fibrosis (CF) in 9, meconium plug syndrome in 19 (including 3 with CF), intestinal atresia in 10 and no formal diagnosis in 17. Median length of neonatal unit stay was 11 days (7–19).ConclusionsInitial management of neonates with distal bowel obstruction should be colonic irrigation since this is therapeutic in the majority and significantly reduces the need for contrast enema. These infants should all have suction rectal biopsy to investigate for HD unless another diagnosis is evident. If a meconium plug is passed, testing for CF is recommended. Evaluation and therapy are multimodal and time consuming, placing burden on resources and families.

Intestinal Obstruction by Meconium Ileus in the Newborn Revealing Cystic Fibrosis

Objective: To report a case of a preterm infant with meconium ileus at birth and cystic fibrosis. Background: The meconium ileus corresponds to the obstruction of the terminal ileum by an abnormally thick meconium; it is observed most often in neonates with cystic fibrosis. Case description: a female infant was born by cesarean delivery section on severe pre-eclampsia with oligohydramnios and intrauterine growth restriction, weighing 1230 g at 36 weeks of gestational age, with Apgar scores of 10/10. His mother was a 26-year-old G2P2 who had attended three prenatal consultations with negative serology for vertical infections. Immediately after birth, the newborn was referred to our neonatal critical care unit due to severe abdominal distension. the Newborn had a delay in meconium emission of more than 48 hours. an abdominal X-ray showed significant intestinal distension and a barium enema was performed showing meconium plugs with a colon of normal topography and caliber, initially put on antibiotic therapy with enema by gastroraphy twice a day, an etiological assessment was carried: A genetic study was conducted, revealing that the newborn is a carrier of a variant (c.1521-1523delCTT,p.Phe508del F50 del) associated with a classic form of cystic fibrosis in a homozygous state and the first immunoreactive trypsinogen (IRT) was &gt; 1300 ug/l (reference value &gt;1000 ug/l), in view of the non-improvement the newborn benefited from an ileostomy. Comments: This case illustrates the rapid evolution of CF in a premature patient with meconium ileus as the first clinical manifestation.

Meconium plug syndrome in twins

Meconium plug syndrome in twins

P-019 Prevention of meconium plug and watery mouth syndrome by colostrum feeding and enema in anorectic newborn lambs

P-019 Prevention of meconium plug and watery mouth syndrome by colostrum feeding and enema in anorectic newborn lambs

Neonatal Meconium Plug Caused Severe Proximal Small Bowel Dilatation and Made A Misinterpretation of Pneumoperitoneum

&lt;p&gt;There is a high mortality rate for infants with visceral perforations. Clinical imaging of this condition includes free air in the abdomen with abdominal plain radiography or lateral decubitus radiographs. An important disease that is easily ignored in the perinatal period is meconium plug syndrome, which causes functional obstruction in the colon that leads to dilated bowel loops in abdominal plain radiography. We report a female newborn who had a suspected bowel obstruction during prenatal examination because of polyhydramnios. The initial plain abdominal film showed a large volume of air accumulation in the peritoneum. An emergent exploratory laparotomy was performed and it revealed that there was no free a3 ir nor ascites in the peritoneal cavity. The proximal small bowel was severely dilated and a meconium plug at the splenic flexure was found. The image of air in the patient&amp;rsquo;s small bowel and peritoneal cavity in the anterior&amp;ndash;posterior view and image of the left decubitus view of the abdomen were similar in this case to the degree that the clinicians could not differentiate them, leading to an unnecessary exploration laparotomy.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Contrast Enema: Solving Diagnostic Dilemmas in Neonates With Lower Intestinal Obstruction.

BackgroundAnatomical abnormalities leading to bowel movement failure are the major cause of intestinal obstruction. This study was done to assess the diagnostic efficacy of contrast enema in neonates with lower intestinal obstruction.MethodologyThis prospective study was conducted in The Children’s Hospital and University of Child Health Sciences, Lahore from February 2021 to July 2021. Patients presenting with constipation, abdominal distension, vomiting, and unable to pass meconium, evaluated clinically and by X-rays, were included in the study. Patients with lower intestinal obstruction (i.e., meconium ileus, Hirschsprung’s disease, ileal atresia, meconium plug syndrome, and small left colon) were given contrast enema (gastrografin) after hydration. The radiologist was blinded by the clinical diagnosis or reference standard diagnosis, which was labeled prior to image interpretation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for major contrast enema diagnosis.ResultsDuring this period, a total of 34 patients were included in the study. The mean age of presentation was 72.0 ± 24 hours. There were 21 (61.8%) boys and 13 (38.2%) girls, representing a male to female ratio of 1.7:1. In four cases, our diagnosis on the basis of contrast enema was proven wrong. Sensitivity, specificity, PPV, and NPV of Hirschsprung’s disease were found to be 93.3%, 50%, 87.5%, and 66.7%, while these were 84.6%, 66.7%, 91.7%, and 50.0%, respectively, for meconium ileus.ConclusionThe diagnostic efficacy of contrast enema was found to be good in neonates with lower intestinal obstruction. The spectrum of intestinal obstruction among neonates shows diversity while contrast enema seems to play a major role in the identification and remodeling of the diagnostic plan in a major proportion of cases.

STUDY OF INTESTINAL OBSTRUCTION AMONG NEONATES

Failure to pass meconium by a full-term neonate within the rst 24 hours should raise a suspicion of bowel obstruction . The commonest reported causes of bowel obstruction in decreasing order includes anorectal malformations, duodenal atresia , jejunoileal atresia , Hirschsprung's disease , meconium ileus and meconium plug syndrome(1) . Other neonatal medical conditions like hypothyroidism , hypokalemia , sepsis and congestive heart failure are also reported to cause bowel obstruction (2). The aim of this observational cross sectional study of 60 patients from Dec. 2016 to June. 2018 was to study the types and clinical features of neonatal intestinal obstruction , various modalities of intervention , to study the prognosis and causes of adverse outcome. The study showed that the most common cause of neonatal intestinal obstruction is seen to be anorectal anomalies, predominantly Anorectal Malformations . The diagnosis of these disorders is done with minimal investigations . These anorectal malformations require initial evaluation to rule out associated anomalies and surgical intervention in the form of either anal cut back or stoma creation

Left Small Bowel Syndrome A Case Report and Literature Review

Left small colon syndrome is a rare cause of neonatal obstruction, favored by the existence of a diabetic mother in 40 to 50% of cases. The diagnosis is evoked by ultrasound and confirmed by an opaque enema with water-solubles. The enema will allow a colonic emptying often accelerating the regression of the digestive symptoms (use of gastrografine if necessary). The prognosis is good with symptomatic and conservative treatment. The meconium plug syndrome can also be compared to this condition, which is also part of the functional occlusive syndromes that resolve.

Gastrointestinal Emergency in Neonates and Infants: A Pictorial Essay.

Gastrointestinal (GI) emergencies in neonates and infants encompass from the beginning to the end of the GI tract. Both congenital and acquired conditions can cause various GI emergencies in neonates and infants. Given the overlapping or nonspecific clinical findings of many different neonatal and infantile GI emergencies and the unique characteristics of this age group, appropriate imaging is key to accurate and timely diagnosis while avoiding unnecessary radiation hazard and medical costs. In this paper, we discuss the radiological findings of essential neonatal and infantile GI emergencies, including esophageal atresia and tracheoesophageal fistula, hypertrophic pyloric stenosis, duodenal atresia, malrotation, midgut volvulus for upper GI emergencies, and jejunoileal atresia, meconium ileus, meconium plug syndrome, meconium peritonitis, Hirschsprung disease, anorectal malformation, necrotizing enterocolitis, and intussusception for lower GI emergencies.

Non-Surgical Causes of Bilious Vomiting in Neonates Admitted in a Tertiary Center

Bilious vomiting is highly suggestive of an acute and emergent condition among neonates. The aim of this study was to investigate the non-surgical causes of bilious vomiting in neonates admitted to a tertiary center and to compare them with the surgical causes. This cross-sectional study was performed on 80 infants with bilious vomiting who were admitted at the neonatal intensive care unit of a pediatric tertiary center over two years. The demographic characteristics, clinical symptoms and signs, diagnostic assessments, and therapeutic approaches were recorded. The mean age of neonates was 9.07±8.84 days, and 55% of them were males. The most common final diagnosis was: Necrotizing Enterocolitis (NEC), duodenal atresia, Hirschsprung’s disease, gastroesophageal reflux disease (GERD), volvulus, sepsis, meconium plug, isolated mal-rotation, metabolic abnormalities, imperforate anus, and Ladd’s bands, respectively. Abnormal findings in ultrasound and X-rays were detected in 35% and 46.3%, respectively. About half of the affected neonates were treated non-surgically. Overall, 17.5% of the patients died. Most deaths were seen in infants with NEC. Using multivariable logistic regression analysis, the presence of NEC as an underlying etiology was the only predictor of neonatal death in neonates with bilious vomiting (OR=12.455, 95%CI: 1.365-113.618, P=0.025). The most common cause of bilious vomiting was NEC, followed by duodenal atresia. Half of the neonates with bilious vomiting were treated medically without operation.

A Case Report of Meconium Plug Syndrome with Intestinal Obstruction in a SGA, Preterm 34 Week Gestation Baby

A Case Report of Meconium Plug Syndrome with Intestinal Obstruction in a SGA, Preterm 34 Week Gestation Baby

Bedside upper gastrointestinal series in the neonatal intensive care unit

BackgroundIn neonatal intensive care unit (NICU) patients with intubation status, fluoroscopic evaluation for the bowel is limited. This study was to evaluate the utility of bedside upper gastrointestinal (UGI) series with delayed radiographs (DR) for assessing duodenojejunal junction (DJJ) and small bowel passage in NICU patients with nonspecific bowel ultrasonography and contrast enema findings.MethodsWe reviewed clinical and imaging data for bedside UGI with DR of NICU patients from 2014 to 2019. Five abdominal radiographs were obtained at fixed time intervals of immediately after, 1 min, 5 min, 1 h, and 2 h following the administration of 5 cc/kg isotonic water-soluble contrast agent via the nasogastric tube.ResultsTwenty bedside UGI with DR were performed in 17 patients (weight range: 520-3620 g, age range: 0–4 months). Confidence identifying the DJJ was either good (n = 7) or equivocal (n = 8) at immediate or 1 min radiographs. The DJJ could not be evaluated in five from four delayed passage (including two meconium plug syndrome and one gastric volvulus) and one inadequate timing. There was only one case of intestinal malrotation, which was not detected on ultrasonography, but detected at the first UGI examination with good DJJ confidence.ConclusionsBedside UGI with DR can evaluate intestinal malrotation using immediate and 1 min delay and small bowel passage using 1 and 2 h delay images in NICU patients with nonspecific ultrasonographic and contrast enema findings. The majority with delayed contrast passages can have bowel pathology. Because of a small number of patients in this study, further studies with more infants are needed.

Ultrasound Guided Hydrostatic Treatment of Meconium Ileus; another Indication for Ultrasound Based Approach to Bowel Obstruction

Dear Editor-in-Chief, The inspissated meconium pellets are a cause or effect of ileocolic obstructions. The present study aimed at explaining our experience of ultrasound-based approach for differentiation and treatment of the inspissated meconium pellets. This study was conducted at Mashhad University of Medical Sciences, Mashhad, Iran, from 2017-2020. Twenty-four neonates (less than 8 days) with inspissated meconium pellets were examined using ultrasound. Moreover, in cases with non-complicated inspissated meconium pellets, ultrasound-guided contrast enema was performed for confirmation of the diagnosis or probable treatment. In ultrasound, the inspissated meconium pellets were observed as uniform hypo- to hyper-echoic tubular or beaded intra-luminal material in ileocolic loops or recto-sigmoid area. These pellets were in five states: simple meconium ileus, localized or generalized meconium, small bowel, meconium plug syndrome, and Hirschsprung's disease. During contrast enema in non-complicated meconium ileus, moving and floating of inspissated meconium pellets was observed during ultrasound scanning, while this issue was not observed in small bowel atresia. The success rates of the hypertonic contrast enema in patients with simple meconium ileus were 80%. The inspissated meconium pellets have an ultrasound appearance. They are mainly observed in patients with simple and complicated meconium obstructions and bowel atresia. Except in complicated meconium obstructions, the ultrasound-guided contrast enema was performed for their differentiation and probable treatment.

Bile Stained Vomiting in Neonates: Radiological and Surgical Correlation

Abstract Background: Bile stained vomiting in neonates is fre-quently encountered clinical symptom in pediatric practice. It is very important to examine them and exclude or confirm surgical condition. Aim of Study: This work is advocated to illustrate the spectrum of radiological findings in neonates with bile stained vomiting and correlate them with surgical data. Patients and Methods: All included neonates presented with bile stained vomiting were referred to Diagnostic Radi-ology Department at Sohag University Hospitals. Abdominal X-ray, abdominal ultrasound, Doppler and contrast imaging were done to identify the surgical causes of bilious vomiting with clinical and surgical correlation. The patients were treated surgically in Pediatric Surgery Unit at Sohag University Hospitals. Patients with bilious vomiting caused by non-surgical causes were excluded. Results: Our study included 31 bile stained vomiting neonates with age range from one day to 30 days and with male sex predominance (17 boys and 14 girls). Four patients were found to have necrotizing enterocolitis, 5 cases with mid-gut volvulus, 3 cases were found to have distal duodenal atresia, one case with duodenal stenosis, 5 cases with jejunal atresia, 4 cases with ileal atresia, 2 cases with congenital bands, 2 cases with complicated congenital inguinal hernias, 2 cases with meconium plug, 1 case with neonatal intussus-ception, 1 case with iatrogenic clamping of umbilical hernia and 1 case with anal stenosis. Imaging techniques were diagnostic in most of the cases and correlate with surgical findings. Conclusion: Bile stained vomiting in the newborn usually indicative of surgical conditions and needs surgical consulta-tion. Imaging studies are of utmost important to investigate and diagnose these cases before surgery.

Prenatal Dilated Rectum: Do We Need to Worry?

BackgroundAdvances in prenatal imaging is increasing detection of abnormally dilated bowel. There is no literature to date defining the criteria for a dilated rectum or its association with postnatal pathology. The aim of this study is to investigate the clinical significance of a prenatally identified dilated rectum. MethodsA retrospective review was performed of all cases of “dilated bowel” on prenatal ultrasound between January 2000 and December 2017 at a single institution. We excluded ventral wall defects from review and sought to include only cases of a prominent or dilated rectum. Collected data included prenatal bowel measurements, postnatal diagnoses, need for surgical intervention, and outcomes. Descriptive statistics were applied. ResultsOne hundred and ninety-three cases of prenatal “dilated bowel” were identified in which 12 (6.2%) had specifically visualized a prominent or dilated rectum. Nine of these (75.0%) had no rectal or intestinal abnormality on postnatal evaluation and were discharged feeding and defecating normally. The remaining three cases exhibited clinical pathology necessitating additional management: (1) meconium plug, (2) jejunal atresia with cecal perforation, and (3) rectal perforation with retroperitoneal abscess. All three had rectal biopsies with identification of ganglionated submucosa. ConclusionsAlthough a prenatal dilated rectum is a normal variant in the vast majority of cases, it may be associated with a gastrointestinal abnormality requiring surgical intervention. Interestingly, there were no cases of Hirschsprung's disease or anorectal malformations in this cohort. These results, in conjunction with continued efforts to identify and define rectal dilation, are useful for prenatal counseling and postnatal evaluation.

Probiotics to prevent infantile colic.

Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. Infantile colic affects a large number of infants and their families worldwide. Its symptoms are broad and general, and while not indicative of disease, may represent a serious underlying condition in a small percentage of infants who may need a medical assessment. Probiotics are live microorganisms that alter the microflora of the host and provide beneficial health effects. The most common probiotics used are of Lactobacillus, Bifidobacterium and Streptococcus. There is growing evidence to suggest that intestinal flora in colicky infants differ from those in healthy infants, and it is suggested that probiotics can redress this balance and provide a healthier intestinal microbiota landscape. The low cost and easy availability of probiotics makes them a potential prophylactic solution to reduce the incidence and prevalence of infantile colic. To evaluate the efficacy and safety of prophylactic probiotics in preventing or reducing severity of infantile colic. In January 2018 we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, 10 other databases and two trials registers. In addition, we handsearched the abstracts of relevant meetings, searched reference lists, ran citation searches of included studies, and contacted authors and experts in the field, including the manufacturers of probiotics, to identify unpublished trials. Randomised control trials (RCTs) of newborn infants less than one month of age without the diagnosis of infantile colic at recruitment. We included any probiotic, alone or in combination with a prebiotic (also known as synbiotics), versus no intervention, another intervention(s) or placebo, where the focus of the study was the effect of the intervention on infantile colic. We used standard methodological procedures of Cochrane. Our search yielded 3284 records, and of these, we selected 21 reports for full-text review. Six studies with 1886 participants met our inclusion criteria, comparing probiotics with placebo. Two studies examined Lactobacillus reuteri DSM, two examined multi-strain probiotics, one examined Lactobacillus rhamnosus, and one examined Lactobacillus paracasei and Bifidobacterium animalis. Two studies began probiotics during pregnancy and continued administering them to the baby after birth.We considered the risk of bias for randomisation as low for all six trials; for allocation concealment as low in two studies and unclear in four others. All studies were blinded, and at low risk of attrition and reporting bias.A random-effects meta-analysis of three studies (1148 participants) found no difference between the groups in relation to occurrence of new cases of colic: risk ratio (RR) 0.46, 95% confidence interval (CI) 0.18 to 1.19; low-certainty evidence; I2 = 72%.A random-effects meta-analysis of all six studies (1851 participants) found no difference between the groups in relation to serious adverse effects (RR 1.02, 95% CI 0.14 to 7.21; low-certainty evidence; I2 not calculable (only four serious events for one comparison, two in each group: meconium plug obstruction, patent ductus arteriosus and neonatal hepatitis).A random-effects meta-analysis of three studies (707 participants) found a mean difference (MD) of -32.57 minutes per day (95% CI -55.60 to -9.54; low-certainty evidence; I2 = 93%) in crying time at study end in favour of probiotics.A subgroup analysis of the most studied agent, Lactobacillus reuteri, showed a reduction of 44.26 minutes in daily crying with a random-effects model (95% CI -66.6 to -21.9; I2 = 92%), in favour of probiotics. There is no clear evidence that probiotics are more effective than placebo at preventing infantile colic; however, daily crying time appeared to reduce with probiotic use compared to placebo. There were no clear differences in adverse effects.We are limited in our ability to draw conclusions by the certainty of the evidence, which we assessed as being low across all three outcomes, meaning that we are not confident that these results would not change with the addition of further research.

Should we look for Hirschsprung disease in all children with meconium plug syndrome?

BackgroundMeconium plug syndrome (MPS) is associated with Hirschsprung disease (HD) in 13–38% of cases. This study sought to assess institutional variation in utilization of rectal biopsy in children with MPS and the likelihood of diagnosing HD in this population. MethodsPatients with MPS on contrast enema in the first 30 days of life from the Pediatric Health Information System database in 2016–2017 were included. Institutional rates of rectal biopsies performed during the initial admission were calculated and then used to predict institutional rates of early HD diagnoses using Poisson regression. ResultsOf 373 newborns with MPS, 106 (28.4%) underwent early rectal biopsy, of whom 43 (40.5%) had HD. Fifty-seven (15.3%) were ultimately diagnosed with HD. Eight (14%) of these patients had a delayed diagnosis. HD rates between institutions did not differ significantly (range 0–50%, p=0.52), but usage of early rectal biopsy did (range 0–80%, p=0.03). Each additional early biopsy increased the early HD diagnosis rate by 35% (β=0.30, 95% CI 0.15–0.45, p<0.0001). ConclusionThe incidence of HD is increased in children with MPS. There is significant hospital variability in the utilization of early rectal biopsy, and opportunity exists to standardize practice.Type of Study: Study of Diagnostic testLevel of Evidence: Level III

Neonatal Intestinal Obstruction: A 5 Year Experience in a Tertiary Hospital in Enugu, Nigeria

Background: Neonatal intestinal obstruction is one of the most common surgical emergencies in a newborn requiring the services of a pediatric surgeon. This study reports the etiology, sex incidence, age of presentation, management and outcome of neonatal intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of neonates who presented, at Enugu State University Teaching Hospital, with intestinal obstruction over a 5-year period. Result: Thirty five neonates were recruited into the study. There were 24 (68.6%) males and 11 (31.4%) females. Five patients (14.3%) were delivered before term (preterm) while thirty patients (85.7%) were delivered at term. Most of the patients (54.3%) presented after 72 hours from onset of symptoms. Abdominal distension was the most common symptomatology recorded in our patients. Necrotizing enterocolitis was the most common etiology in our patients accounting for 17 neonates (48.6%). This was followed by anorectal malformation 5 (14.3%), obstructed hernia 4 (11.4%), intestinal atresia 4 (11.4%), Hirschsprung’s disease 3 (8.6%), meconium plug 2 (5.7%). Colostomy formation was the most common surgical procedure performed. Twenty percent of our patients developed post-operative complication and mortality was 22.9%. Conclusion: Necrotizing enterocolitis is the most common cause of neonatal intestinal obstruction in the current study. With the mortality of 22.9%, the outcome in our patients is still poor and requires some improvements.

Review. Gastrointestinal Surgery in Neonates: Practice, Facts, and Trends

The author presents an overview of the current trends in acute neonatal gastrointestinal surgery. Necrotizing enterocolitis and focal intestinal perforation are disorders of different etiology, appearance, and prognosis. In neonates with focal perforation, a good prognosis can be expected. Primary anastomosis is a valid option for primary surgery. Meconium ileus is based on obstruction of the terminal ileum. Medical treatment is the primary therapeutic option, although surgery may be required. In contrast, meconium plug syndrome is based on stool plugging in the left colon, and surgery is not appropriate. Hirschsprung’s disease is confirmed on the basis of representative biopsy of the rectum just above the dentate line. There is a trend toward a single-step pull-through operation without protective stoma. Open hernia repair in small neonates can be performed via a mini-incision and without opening the external inguinal ring. Laparoscopic hernia repair has some advantages, especially in girls. In infants with pyloric stenosis, laparoscopic pyloromyotomy is a first line option for treatment. There is a general trend toward single-stage procedures and laparoscopic reconstructive surgery for gastrointestinal malformations. With the exception of tracheoesophageal fistula and low bowel obstruction, the vast majority of upper gastrointestinal malformations can be identified using prenatal ultrasound examination. One-stage repair with excellent results is even possible in neonates below 1000 g. Surgery of duodenal or small bowel atresia can be performed following the postnatal adaptation period. For some forms of anorectal malformation, the need for a protective stoma has been questioned in the last decade. Posterior sagittal anorectoplasty remains the standard procedure for the majority of cases. Midgut or segmental volvulus affects different groups of infants. If a neonate is suspected of having any type of volvulus, urgent surgery is required. Intestinal duplication carries a high risk for complications, and surgery should be performed on an elective basis.