Neonatal surgical problems of the chest

Neonatal surgical problems of the chest include a wide spectrum of anomalies that extend from chest wall deformities to developmental cardiac malformations. To remain within the scope of this publication, cardiac anomalies and chest wall deformities are excluded.Most neonatal chest conditions have other associated anomalies such as chromosomal anomalies that may form part of more complex syndromes. In the era before prenatal diagnosis many of these conditions would present as fetal loss or asymptomatically and discovered incidentally during postnatal imaging. Prenatal diagnosis has revolutionized the diagnosis and treatment of chest conditions.Congenital cystic lung lesions have a prenatal diagnostic accuracy of almost 100% and are mainly asymptomatic at postnatal presentation. The diagnosis may be confirmed on postnatal computerized tomography (CT) scan, however the treatment of these asymptomatic lesions remains controversial. Most institutions offer surgery to avoid future complications however surveillance with or without imaging an alternate management.More than 60% of cases with prenatally diagnosed congenital diaphragmatic hernia do not make it beyond the neonatal period. Complex associated anomalies and lung hypoplasia are the prime causative factors for this grim outcome. Even those infants that survive post-surgical repair some will have respiratory, gastrointestinal and neurological sequeli.Chylothorax and thoracic teratoma are other thoracic conditions discussed.Diagnosis of oesophageal atresia is less accurate on prenatal scan. Surgery could be challenging and outcomes are dependent on associated anomalies.