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Considerations surrounding care of the pediatric surgical patient can differ markedly from that of their adult counterparts. This is not only due to differences in the pathophysiology of surgical diseases that affect neonates, infants, and children, but also differences in the physiologic demands of illness across different stages of development. Management of pediatric surgical diseases therefore requires an intimate understanding of not only the embryology and pathophysiology of pediatric surgical diseases, but also the unique physiologic requirement requirements of the pediatric population in response to stress and injury.
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Neonatal Intensive Care
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Care of surgical neonates, particularly premature and small for gestational age infants, continues to improve over time with advances in technology and medical therapy in neonatal intensive care units. Neonates with surgical disease often have comorbid conditions that threaten survival and necessitate multidisciplinary care.
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Temperature is controlled by servoregulation, whereas pulse and blood pressure are continuously recorded. Ventilation is monitored by transcutaneous oxygen (O2) and carbon dioxide (CO2) electrodes or by indwelling arterial catheters. The metabolic consequences of prematurity and intrauterine growth retardation are monitored by frequent measurement of glucose, calcium, electrolytes, and bilirubin in microliter quantities of blood. Nutritional requirements for growth and development can be provided by enteral or parenteral routes. This kind of specialized care of critically ill newborns requires trained personnel and specialized equipment. The care of such babies is best accomplished in designated regional centers capable of providing pediatric surgical and neonatal intensive care.
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Neonates are classified according to their gestational age and weight. A premature infant has a gestational age of less than 37 weeks, a term infant has a gestational age of 37-42 weeks, and a postmature infant has a gestational age of greater than 42 weeks. The gestational age of the infant is calculated from the date of the last normal menstrual period; however, clinical assessment of gestational age by morphologic and neurologic examination may be more accurate. For a term infant, normal birth weight is greater than 2500 g, whereas low birth weight, very low birth weight, and extremely low birth weight are defined by weights of 1500-2500 g, 1000-1500 g, and less than 1000 g, respectively.
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Several clinical exam findings may be useful in assessing gestational age. Infants less than 37 weeks’ gestational age may have (1) fine fuzzy hair with thin, semitransparent skin; (2) ears that lack cartilaginous support; (3) a breast nodule less than 3 mm in diameter; and (4) few transverse creases on the balls of the feet anteriorly. In males, the testicles may be undescended and reside in the inguinal canal, and the scrotum is small with few rugae. In females, the labia minora are relatively enlarged and the labia majora are small.
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Premature infants may have ...