# Neonatal Surgical Conditions — GCMD Library living collection

Updated: n/a · 2 episodes · 13 cited statements

## Episodes
### Pyloric Stenosis
- [Pyloric Stenosis with Dr. Alex Bondoc](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728) — podcast · 16:20 · [machine version](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728.md)

### Postoperative Acute Kidney Injury
- [Association between Elevated Urine Neutrophil Gelatinase-Associated Lipocalin and Postoperative Acute Kidney Injury in Neonates](https://library.globalcastmd.com/watch/association-between-elevated-urine-neutrophil-gelatinase-associated-lipocalin-an-16027) — article · [machine version](https://library.globalcastmd.com/watch/association-between-elevated-urine-neutrophil-gelatinase-associated-lipocalin-an-16027.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=0) Introduction and Case Presentation (Ep 1)
- [3:05](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=185) Epidemiology and Risk Factors (Ep 1)
- [4:37](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=277) Physical Exam and Diagnostic Workup (Ep 1)
- [6:36](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=396) Medical Management and Stabilization (Ep 1)
- [8:07](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=487) Surgical Technique and Procedure (Ep 1)
- [13:49](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=829) Post-operative Care and Outcomes (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Pyloric stenosis incidence is approximately 4 to 5 in 1000 live births with heavy male preponderance. — Alex Bondoc (epidemiological) [Ep 1 · 3:05](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=185)
- Atropine is traditional medical management but has fallen out of favor because pediatric anesthetists are skilled and there is low concordance between congenital anomalies creating high anesthetic risk. — Alex Bondoc (opinion) [Ep 1 · 7:34](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=454)
- The first pyloromyotomy was performed the year before Ramstedt, who popularized it using a coffee spoon, intending pyloroplasty but performing only myotomy when the baby became unstable. — Alex Bondoc (clinical) [Ep 1 · 8:40](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=520)
- Gastric suction in three positions (head down, right, left) while awake is performed before induction to prevent aspiration from the atonic stomach. — Alex Bondoc (clinical) [Ep 1 · 9:16](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=556)
- For laparoscopic pyloromyotomy, 3-millimeter instruments are used through three incisions: umbilicus, right upper quadrant, and left upper quadrant. — Alex Bondoc (clinical) [Ep 1 · 10:12](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=612)
- The 3-millimeter Maryland grasper when fully opened is 13 millimeters, so a 13mm myotomy on a 15-18mm channel will be incomplete. — Alex Bondoc (clinical) [Ep 1 · 10:57](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=657)
- Air can be insufflated down a suction catheter to look for bubbles indicating mucosal perforation. — Alex Bondoc (clinical) [Ep 1 · 12:05](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=725)
- Omentum is placed on top of the myotomy site. — Alex Bondoc (clinical) [Ep 1 · 12:20](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=740)
- Open pyloromyotomy can be performed through a periumbilical incision with tunneling up to the right upper quadrant, taking advantage of babies' stretchable skin. — Alex Bondoc (clinical) [Ep 1 · 12:27](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=747)
- Incisional hernias can occur because fascia is typically not closed on stab incisions in upper quadrants; omental hernias have been observed. — Alex Bondoc (clinical) [Ep 1 · 13:06](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=786)
- Complication rates after pyloromyotomy are equivalent or better with open approach because laparoscopic pyloromyotomy is an experience and feel operation. — Alex Bondoc (opinion) [Ep 1 · 13:23](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=803)
- Post-operative vomiting is very common and does not necessarily mean the operation did not work; the atonic stomach does not remodel immediately. — Alex Bondoc (clinical) [Ep 1 · 13:54](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=834)
- Complete intolerance of feeds lasting into days post-operatively raises concern for incomplete myotomy. — Alex Bondoc (clinical) [Ep 1 · 14:13](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=853)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 1 · 3:24](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=204)
- Uninsured families' babies had lower chloride and higher bicarbonate levels at presentation and longer times between diagnosis and OR. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 1 · 3:44](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=224)
- A large-scale Denmark and Holland study found pyloric stenosis is 87% heritable. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 1 · 4:13](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=253)
- Researchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 1 · 4:25](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=265)
- Ultrasound diagnostic criteria: muscle thickness greater than 4 millimeters and pyloric channel length greater than 15 millimeters suggest pyloric stenosis. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 1 · 6:23](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=383)
- A 2008 and 2016 Journal of Pediatric Surgery study identified specific fluid resuscitation pathways that reduced blood draws and did not delay time to surgery. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 1 · 6:46](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=406)
- Recommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride). — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 1 · 7:04](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=424)
- Nasogastric decompression should be avoided to prevent exacerbation of metabolic alkalosis. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 1 · 7:18](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=438)
- A 2023 Journal of Pediatric Surgery study suggests antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 1 · 8:12](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=492)
- To assess myotomy completeness, both ends of separated muscle should move independently; resistance or connected movement indicates incomplete myotomy. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 1 · 11:49](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=709)
- A flexible feeding protocol (reducing volume if baby vomits 6 times but continuing smaller feeds and increasing as tolerated) decreases length of hospital stay. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 1 · 14:30](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=870)
- Studies on adults who had pyloromyotomy as children show they do not have major issues like nausea, vomiting, reflux, or other GI problems later in life, and long-term follow-up is usually not necessary. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 1 · 15:08](https://library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=908)

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