Neonatal surgery

Neonatal surgeons in Denver

The general surgeons within the Rocky Mountain Pediatric Specialists medical group in the Denver area provide experienced, expert care to babies who require corrective surgery shortly after they are born. When your newborn needs surgery, you want him or her to receive the best care possible from specialists who are knowledgeable and compassionate.

If you have a high-risk pregnancy or have questions for our neonatal surgical team, please call us at (303) 839-6001.

Surgeons recognized for experience and innovation

Our pediatric general surgeons are board certified, fellowship trained and skilled in the most advanced surgical techniques for children of all ages. For many procedures, we were first in the world, the country and the region to perform them. For example, the first-ever thoracoscopic repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF), thoracoscopic lung lobectomy, and laparoscopic repair of intestinal atresia were performed by our general surgeons.

In addition to our surgeons' expertise, providing care at Rocky Mountain Hospital for Children means we have access to state-of-the-art equipment designed especially for smaller patients as well as a larger team of support staff and providers who focus on pediatric care and understand that kids need to be treated differently than adults physically, mentally and emotionally.

Minimally invasive surgery

Minimally invasive surgical techniques using smaller incisions are rapidly becoming the standard for many surgeries due to the decreased risk of complications and faster recovery period. Our team has led the way in minimally invasive surgery for children, adapting and innovating to provide these procedures for our young patients.

Diagnosing congenital disorders

Many congenital disorders that need to be corrected surgically are now routinely diagnosed before birth using advanced imaging techniques. When a congenital disorder is identified, the progress of the disease is carefully monitored by a perinatologist and a prenatal consultation will take place with a surgeon to discuss your baby's treatment plan.

Neonatal conditions we treat

We offer minimally invasive neonatal surgery for a wide range of congenital conditions, including:

• Congenital lung conditions — such as congenital pulmonary airway malformation (CPAM)
• Diaphragmatic hernia — a condition in which a hole forms in the muscle that separates the chest from the abdomen
• Duodenal atresia — the upper part of the small bowel has not developed properly
• Esophageal artresia (EA) — a condition where the baby's esophagus develops improperly
• Hirschsprung's disease — a condition in the colon in which the child has problems passing stool
• Imperforate anus — a blocked or missing anus
• Intestinal atresias — part of the bowel that has not fully developed, causing the intestinal tract to become obstructed
• Malrotation — a condition in which the baby's intestine doesn't rotate in the right way
• Ovarian masses — growths on or in the ovaries
• Sacrococcygeal teratoma — rare tumors that form at the bottom of the spine by the tailbone
  
• Twin-to-twin transfusion syndrome — a condition in which twins share one set of blood vessels that supply oxygen and nutrients essential for development in the womb
  

Congenital pulmonary airway malformation

Our team has special interest and experience in caring for babies with CPAM (congenital pulmonary airway malformation). A CPAM baby has a condition in which a mass grows in a fetus’ lung. The growth does not function as lung tissue and takes the place of normal, healthy tissue. The growth usually needs to be removed surgically, as they can become infected or be pre-cancerous, through a procedure called a thorascopic lobectomy. This type of surgery can be performed with minimally invasive techniques using tiny incisions and instruments. Our team has the largest series of thoracoscopic lobectomies in the world.

Babies diagnosed with CPAM prenatally undergo regular ultrasounds to monitor the CPAM lung and to keep an eye on signs of fetal hydrops, a rare but serious complication of CPAM. Sometimes, the mother will “mirror” the condition and develop preeclampsia.

Babies who do not develop fetal hydrops can be carried to term without treatment but should be delivered at a hospital with a Level IV Neonatal Intensive Care Unit (NICU), such as the Level IV NICU at RMHC. There, we can monitor the baby and plan treatment while high-level care is provided to ensure health and safety.

Treatment for CPAM

When surgery is needed to remove the growth depends on what symptoms our team sees immediately after birth. If the baby doesn't have any breathing problems, surgery can be performed at a later time but is usually done before his or her first birthday. However, if the growth is large and interferes with breathing, surgery must be done right after birth.

When the growth is properly removed, the child usually has no long-term complications and can lead a normal, active life.

Esophageal atresia with tracheoesophageal fistula

Esophageal atresia (EA) with tracheoesophageal fistula (TEF) in a newborn is a type of congenital abnormality that occurs when the esophagus connects to the trachea (windpipe) instead of growing as one tube, leaving a gap between the esophagus and stomach. This means food cannot pass from the mouth to the stomach and liquid may go from the mouth into the lungs. While sometimes this condition is suspected during pregnancy, it is most often diagnosed after birth.

Esophageal atresia with tracheoesophageal fistula symptoms

Symptoms that may be seen in a EA/TEF baby include:

• Difficulty breathing
• Difficulty swallowing
• Frothy bubbles at mouth
• Inability to feed normally (coughing, choking, turning blue)
• Vomiting

Diagnosing tracheoesophageal fistula

To diagnose tracheoesophageal fistula, the team will try to pass a tube from the mouth to stomach and then take an X-ray to examine the anatomy. If diagnosed, surgical treatment is necessary to correct this condition. Our team uses the latest minimally invasive techniques to reduce the impact on the baby’s body from surgery.

Our team performed the first thoracoscopic repair — a minimally invasive, image-guided technique offering superior visualization for treating conditions of the chest — of TEF in the world.

TEF is a condition under the umbrella of esophageal atresia (EA), which includes any abnormal formation of the esophagus. EA is seen in an estimated one of 4,000 live births, and our team is highly qualified and experienced in techniques to correct all types of EA.

Comprehensive care throughout pregnancy

We work closely with The Maternal Fetal Center, the high-risk perinatal group and the neonatal intensivists at Rocky Mountain Hospital for Children, to offer a comprehensive consulting and management program for infants and mothers. When congenital defects are identified, fetal and maternal progress is carefully monitored by the perinatologist to monitor the progress of the disease, and to intervene prenatally if necessary. Meanwhile, the parents are referred to the surgeons for prenatal consultation. Here, parents will learn about the problem, how it is repaired, and other problems the baby may have related to the defect.

Coordinated plans for mom/baby during delivery and treatment

Mothers are brought to Presbyterian/St. Luke’s Medical Center (P/SL) for a planned delivery. The mother is transported to the Mom/Baby unit, which is located near the neonatal ICU so there are no risky transfers to remote facilities for the baby. As the mother recovers, the infant is evaluated and stabilized. Then the baby will undergo treatment with our highly experienced surgeons, staying in close proximity to the mother throughout treatment and recovery.

Our integrated approach allows for close coordination among mom and baby’s care teams and allows both to stay in the same hospital and have procedures completed during the first few days of life.

Multidisciplinary neonatal care team

Our neonatal care integrated approach with close integrated coordination among neonatologists, perinatologists, and our pediatric surgeons gives the best possible clinical outcomes, limits stress on both parent and baby, and minimizes separation between mother and newborn. This is a significant improvement compared to other programs in which mother and child are treated in separate hospitals, surgery is delayed until the child is larger, and standard open techniques are used which produce greater pain and longer hospital stays for the child.

What to expect

We believe that minimizing the separation between a mother and their newborn is of the utmost importance and that's why mothers are brought to Presbyterian St. Luke's Medical Center (P/SL) for their planned delivery. At P/SL, the delivery rooms are across the hall from the neonatal ICU, so there are no risky facility transfers for the baby. As the mother recovers, the infant is evaluated and stabilized and then operated on by one of our pediatric surgeons. This integrated approach and close coordination among our neonatal care team gives the best possible clinical outcomes and limits stress on both parent and baby.