[Progress in and outcomes of neonatal surgery over the past 50 years]

The Japanese Society of Pediatric Surgeons has performed a nationwide survey of neonatal surgery every 5 years during the 50 years since its foundation. The number of neonatal surgical cases has increased 5-fold during those 50 years, while the mortality rate has decreased from 60% to 15% for the main life-threatening diseases (such as esophageal atresia, diaphragmatic hernia, omphalocele, and gastroschisis). Currently, most neonatal patients who undergo surgery for severe cardiac or chromosomal anomalies survive. Therefore, pediatric surgeons are aware of the need for cosmetic considerations. Endoscopic surgical procedures and incisions using natural skin creases have been developed to achieve good cosmetic results and improve patients' quality of life. On the other hand, severe life-threatening neonatal surgical cases are still seen, such as patients with diaphragmatic hernia accompanied by severe pulmonary hypoplasia, huge sacrococcygeal teratomas, and neonatal intestinal perforation. Fetal intervention or early delivery should be considered to improve survival. Appropriate initial treatment strategies for intestinal perforation in very low birth-weight infants are needed.