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Diagnosing Surgical Emergencies on the Day of Birth

WILLIAM R. RICHARDSON, M.D.
Am J Dis Child. 1961;102(1):134-150. doi:10.1001/archpedi.1961.02080010136021.
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Infant mortality has been considerably reduced by medical progress during the past several decades. Neonatal and especially natal day deaths have been much less significantly diminished over the same period. Reduced mortality due to prematurity and birth injury has resulted from advances in obstetric and pediatric care. As a result, congenital anomalies have assumed a greater relative significance as a cause of neonatal death. Infant operative risks have decreased following refinements in surgical and anesthetic techniques and improved supportive care. Nevertheless, it is clear that neonatal surgical salvage can be further increased by earlier diagnosis and treatment. Only about one-fifth of the survivors of operations for esophageal atresia come from the large group operated on after the first 48 hours of life. Delay or inaccuracy of diagnosis has recently been reported to have been the major contributing factor in two-fifths of the 56 deaths in a consecutive series of 163

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