Pediatric Surgery at Columbia
Complete Surgical Care for Newborns, Kids, and Teens.

Fetal and Neonatal Surgery

Fetal surgery refers to operations performed on babies still in the womb, while neonatal surgery refers to operations performed on newborns. These types of surgery encompass a wide range of different techniques and are typically used to treat a variety of birth defects.

Key Facts

  • Fetal surgery is performed on unborn babies who have treatable conditions that will worsen as they continue to develop in the womb.
  • Neonatal surgery is performed on infants with defects that cannot be treated while in the womb. Surgery may be done immediately after birth or in the days or weeks that follow.
  • Fetal and neonatal surgery are both highly complex and often risky procedures involving a multidisciplinary team of specialists. However, they can also be lifesaving.

Purpose

Fetal and neonatal surgery are both treatment options meant to correct a variety of birth defects and other conditions.

Fetal Surgery

Fetal surgery is performed on babies while still developing in the womb. This allows doctors to treat a defect as early as possible, possibly preventing it from getting worse.

Fetal surgery is used to treat many different conditions, such as the following:

  • Amniotic band syndrome
  • Bronchopulmonary sequestration of the lung
  • Congenital cystic adenomatoid malformation (CCAM) of the lung
  • Congenital diaphragmatic hernia (CDH)
  • Congenital high airway obstruction syndrome (CHAOS)
  • Fetal anemia
  • Lower urinary tract obstruction (LUTO)
  • Mediastinal teratoma
  • Neck mass
  • Sacrococcygeal teratoma (SCT)
  • Spina bifida (myelomeningocele)
  • Twin anemia-polycythemia sequence (TAPS)
  • Twin reversed arterial perfusion (TRAP) sequence
  • Twin-twin transfusion syndrome (TTTS)

Neonatal Surgery

Neonatal surgery is performed on babies shortly after they are born. It is typically meant to treat conditions that cannot be diagnosed and/or addressed while still in the womb. It may also treat conditions that develop shortly after birth. Babies born premature often require neonatal surgery to correct developmental issues.

Neonatal surgery is used to treat many different conditions, such as the following:

  • Anorectal malformations
  • Annular pancreas
  • Congenital diaphragmatic hernia
  • Esophageal atresia
  • Gastroschisis
  • Heart defects
  • Hirschsprung’s disease
  • Intestinal blockages
  • Lung lesions and tumors
  • Necrotizing enterocolitis
  • Omphalocele
  • Short bowel syndrome
  • Tracheoesophageal fistula

Procedure

There are many different types of fetal and neonatal procedures, depending on the condition being treated. These range from minimally invasive laparoscopic procedures to more invasive open surgery techniques.

Fetal Surgical Procedures

While each fetal surgical procedure will vary according to the condition and even the individual, the following is a general overview of the most common techniques:

  • Needle-Based Therapy: This is the most minimally invasive fetal surgical procedure. In it, doctors use a needle guided by ultrasound, allowing them to draw or insert amniotic fluid, provide or sample blood, and/or place a shunt.
  • Fetoscopic Surgery: In this minimally invasive procedure, a small incision is made on the abdomen so that a thin tube called a fetoscope can be inserted into the uterus. This allows doctors to look at and operate on the fetus.
  • Open Fetal Surgery: In this procedure, a large incision is made across the abdomen and another into the uterus. This gives doctors full access to the fetus so that they can perform surgery.
  • Ex Utero Intrapartum Treatment Procedure (EXIT): This procedure is done when the baby is likely to have critical health issues immediately following birth. It involves making a Cesarean section, using a special device to both open the uterus and control bleeding, then operating on the baby while they remain attached to the placenta. 

Neonatal Surgical Procedures

Like fetal surgery, neonatal surgical procedures are unique to each condition. They can include minimally invasive procedures (often used to treat digestive issues, such as atresia), as well as more involved open surgical procedures, such as those used to treat heart and lung defects.

Alternatives

Fetal and neonatal surgery are typically only considered when treatment is absolutely necessary and no other viable alternatives exist.

Risks and Complications

Due to the complexity of fetal and neonatal surgery, as well as the seriousness of the conditions they treat, these procedures come with a variety of potential risks for both the baby and mother. In addition to surgical complications (e.g., bleeding or infection), these include the following:

  • Early labor and delivery
  • Failure to repair defect
  • Fetal death
  • Gestational diabetes
  • Infertility
  • Uterine rupture

Patients and their families should discuss specific risks and complications with a doctor prior to surgery.

What to Expect Afterwards

By intervening early, fetal and neonatal surgery can significantly improve the quality of life for a child and even save their lives. However, the outcome of these surgeries will depend on a range of factors, such as the specific condition and its severity, the surgical procedure, and the health of the patient. 

Fetal Surgery

In general, patients will remain at the hospital for several days after surgery so that doctors can monitor them for any signs of complications. This will likely involve daily ultrasounds to look at the baby’s condition, as well as daily echocardiograms to check the baby’s heart. Mothers will also be checked frequently for signs of preterm labor, infection, and other common issues. After discharge, mothers will likely need to make weekly visits for ultrasounds and other tests.

When it comes time to deliver the baby, mothers who had open fetal surgery will have to deliver via Cesarean section to prevent the surgical wound from rupturing. Mothers who had minimally invasive fetal surgery may still be able to deliver vaginally, but should consult with their doctors.

Neonatal Surgery

Infants who receive surgery will likely need at least several days to recover, but may sometimes require several weeks or months depending on their condition and any complications that arise. These complications may include infections, feeding and/or digestive issues, or more serious problems involving the heart or lungs. Because of these potential risks, infants will remain under close observation in the neonatal intensive care unit (NICU) until their health has improved.

Next Steps

Our pediatric program offers a full spectrum of services for treating congenital conditions in both fetuses and newborn children. We work across disciplines to assemble diverse teams of specialists capable of addressing any condition. Our innovative work in the fetal and neonatal surgical fields has led to newer and more effective ways of addressing congenital defects. It’s also given us a proven track record of building teams that can care for the most difficult fetal and maternal conditions.

Call us at (212) 342-8585 or use our online form to schedule an appointment.  

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