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Neonatal Surgery is the sub-discipline within paediatric surgery that deals with surgically treating congenital and acquired illnesses in newborns and infants up to one month old.
This is a highly complex sub-speciality that only exists at tertiary paediatric centres. The past few decades have brought about important advances, thanks to improvements in diagnostic techniques, neonatal intensive care and anaesthetics, and surgical techniques and materials. These have radically changed the prognosis for both birth defects and acquired surgical pathologies in newborns.
Neonatal surgery requires detailed knowledge of complex pathologies in patients who also have special conditions that are different from other paediatric patients. The Neonatal and Foetal Surgery Unit covers practically every surgical neonatal pathology, and it is a reference centre both nationally and on a European level. It is part of ERNICA, the European Reference Network (ERN) for Rare Inherited and Congenital Digestive Disorders. In recent years, the Unit has been firmly committed to introducing minimally invasive surgical techniques, achieving excellent results.
We work in conjunction with the Neonatology Department. The Neonatal Intensive Care Unit (NICU) at Vall d’Hebron Hospital is one of the largest in the country and has one of the best survival rates. We have the possibility of performing surgical interventions within the NICU if transporting the newborn patient to the surgical wing would be too risky due to the instability of their condition.
Similarly, we work closely with the Foetal Medicine Unit, whose services include all the currently valid prenatal and intrapartum (EXIT technique) foetal surgery techniques.
The Unit participates in the following sessions and committees: Neonatal Medical-Surgical Session (Tuesdays at 1 pm), Paediatric Airway Committee, Birth Defects Committee.
Within our areas of interest, we highlight oesophageal atresia, a pathology for which our overall survival rate exceeds 95% in patients who do not present complex associated malformations. Patients with long-gap oesophageal atresia continue to be a challenge, as the distance between the ends is so great that a primary repair cannot be done. In these complex patients, besides applying the different classic techniques, we use the Foker technique, which consists of sustained traction on the ends to be connected in order to stimulate their growth, so that oesophageal anastomosis can finally be achieved. In those patients for whom the native oesophagus cannot be saved, we carry out oesophageal substitution via gastric pull-up, with excellent short-term and long-term results.
We have established a comprehensive treatment plan for patients affected by a congenital diaphragmatic hernia (CDH), which includes foetal treatment (using the FETO technique: Foetal Endoscopic Tracheal Occlusion) in cases where CDH has been diagnosed in the foetus and the prognosis is not good. In addition, the hospital offers every type of invasive and non-invasive respiratory support and therapy available today: synchronised mechanical ventilation, HFOV, CPAP, treatment with inhaled nitrous oxide, and ECMO (extracorporeal membrane oxygenation), providing cardiovascular and respiratory support when conventional treatment proves ineffective. In patients with large diaphragmatic defects, we use several types of patches, both synthetic and biological ones, and techniques that use autologous muscle flaps, generally from the abdominal wall.
The main abdominal wall defects we find are gastroschisis and giant omphalocele. We are especially proud of how we handle gastroschisis, which can be associated with severe medical-surgical problems due to the inflammation and thickening of the exposed intestinal loops caused by the irritation produced by the amniotic fluid at the end of gestation. Since 2002, we have been carrying out a strategy to avoid this, consisting of performing a scheduled Caesarian section at 34-35 weeks of gestation. This elective preterm C-section technique allows for the abdominal defect to be closed directly, as it reduces exposure to amniotic fluid. With more than 50 patients treated this way, we have not observed complications linked to prematurity. Instead, we have detected a decrease in the associated complications, an earlier introduction to food, and a reduced hospital stay, as well as better aesthetic outcomes, since the scar is hidden by the belly button. We have vast experience in treating giant omphalocele. For this, we use surgical techniques that employ vascularised flaps, biologic or synthetic mesh, and vacuum-assisted closure (V.A.C.®).
Our overall survival rates for acquired surgical pathologies such as necrotising enterocolitis and intestinal perforation (both in premature and LGA premature - with a birth weight of less than 750g - babies) is comparable to other European reference centres. This is thanks to the application of our philosophy of minimally aggressive surgery and conservative treatment; applying these principles is the underlying reason for our high rates of survival and preservation of native intestine.
Intrauterine or peripartum surgery
Pathologies of the disgestive tract
Pathologies of the abdominal wall
Pathologies of the lungs and respiratory tract
Others
The Paediatric Maxillofacial Surgery Unit is proud of its extensive experience in the treatment of complex cranioencephaly malformations. We should also highlight the treatment of paediatric maxilofacial tumours.
Our team is made up of paediatric surgeons who are a part of the Paediatric Surgery Department, and surgeons from the Oral and Maxillofacial Surgery Department.
One example of the work our team carries out is the application of nasoalveolar modelling (NAM) technique to treat children suffering from cleft lip and palate. This treatment is incorporated in the protocol of comprehensive treatment offered to such patients at our centre. This helps surgeons and improves the aesthetic and functional results of reconstructive surgery, as it reduces the severity of the deformity and can easily be carried out in the consultation in a way that is safe and pain-free.
At the Hepatobiliary and Pancreatic Surgery and Transplant Department, we dedicate ourselves to hepatic (liver), pancreatic and biliary surgery, as well as cancer surgery. This mainly involves surgery related to the surgical and onco-surgical treatment of tumours or liver metastases, liver and bowel transplants in children and adults, and intestinal transplants. Our Children’s Liver Transplant Programme is the only one of its kind in Catalonia, and one of just five in Spain. Our excellent results make us a national leader.
The Hepatobiliary and Pancreatic Surgery and Transplant Department is highly specialised, and is independent of the General Surgery Department, which is not very common in general surgery departments. We are organised into two sections: one section devoted mainly to liver surgery and liver and intestine transplants, and another aimed at pancreatic surgery and advanced laparoscopic surgery.
Vall d'Hebron was the first health centre in Spain to carry out a paediatric liver transplant in 1985. With more than 30 years of accumulated experience acquired since the first transplant was carried out, the hospital is home to an amazing group of professionals: anaesthetists, intensivists, radiologists, gastroenterologists, hepatologists and more, all trained to treat the most complex cases with very high survival rates. This survival rate is more than 90% at five and six years after the transplant. We are deeply proud that we have been able to achieve such figures.
To do so, and to offer the best service to our patients, we work closely with other hospital departments, mainly with Internal Medicine and Hepatology, Intensive Care, Oncology, Gastroenterology, Radiology and Pathological Anatomy.
At the Paediatric Intensive Care Unit of Vall d'Hebron University Hospital, we provide life support treatment. We treat patients who, when an organ fails, require specific treatment to replace that organ’s function. We are a leading reference ICU for congenital heart disease, solid organ transplants, neurocritical patients, burns and spinal cord injuries.
Our mission as a paediatric ICU is to take care of children's health, through effective, efficient and quality health care in the treatment of diseases.
More specifically, our objectives are:
To achieve these goals and treat children with specific illnesses and different physiological conditions, a highly qualified team and innovative technology are essential for us to adapt to the reality of each specific case.
Paediatric Intensive Care professionals require specific training. All our staff are highly qualified to recognise signs of serious conditions and the complications that might go with them, as well as being able to decide the correct doses for treatments. The combined expertise of our team is the key behind the prestige the Paediatric Intensive Care Unit enjoys internationally.
The Paediatric ICU is open to families. Not only do the parents and children accompany their baby, but so do the brothers and sisters through the Siblings Project, a pioneering project that began in 2014 at the request of a child who wanted to see his brother who had been admitted.
Both families and patients can benefit from the Sol Solet Programme, where we organise an ICU outing to sunbathe as a family. Nothing is left to chance on these outings.
Our Paediatric ICU came to life in 1968, and was the first in Spain. Nowadays, it is a specialised area where we have the most innovative technologies to allow us to apply advanced therapies for children who need specific life support treatment.
The goal of the Paediatric Cardiology Department is to provide care, teaching and research in the field of heart disease, be it congenital or acquired, from before birth up to adulthood. With more than 40 years’ experience offering patient care, this Department created the Adolescent and Adult Congenital Heart Disease Unit (UCCAA) to provide continuity in care for patients with congenital heart disease
The Paediatric Cardiology Department deals with diseases that affect the heart from the foetal period. Foetal cardiology is developed in collaboration with the Obstetrics, Gynaecology and Neonatology Departments, which have all the human and technical resources necessary to guarantee quality care for treatment of heart disease, congenital or otherwise, detected during the foetal period.
In Catalonia, around 600 babies are born every year with congenital heart disease (between 5 and 12 per 1,000 live babies), of which about 25% will need surgical care during childhood.
Thanks to technological advances and improvement in surgical techniques, the survival rate of these patients has increased in recent years. This does mean that more and more children are growing up to develop cardiac insufficiency and suffer heart failure, meaning they will need a heart transplant. In addition, the rate of myocardiopathies, meaning genetic or acquired diseases that affect the strength of the heart muscle, is 1 per 100,000 inhabitants, and about 40% of children die within two years of diagnosis of the disease.
The Adolescent and Adult Congenital Heart Disease Unit (UCCAA) is the result of a collaboration agreement between Vall d'Hebron University Hospital and University Hospital of Santa Creu i Sant Pau, to bring together the efforts, resources and experience of the two hospitals with the greatest tradition in treatment of these diseases in a single level three congenital heart disease unit for adolescents and adults.
In order to group together outpatient care for congenital heart disease into a single area, the UCCAA Unit outpatient clinic is located in the Maternity and Children's Hospital, next to the Paediatric Cardiology clinic. This common area allows us to share workstations, databases and tools (3D ultrasound) and makes transfer and continuity of treatment simple, from paediatric age to adulthood, for what is a congenital and lifelong pathology.
Patients who require admission do so at the General Hospital, and stay on the Cardiology and Cardiac Surgery ward. Depending on their clinical circumstances, some of these adult patients with congenital heart disease must be admitted onto special wards:
Patients in critical condition: Coronary and Intensive Cardiological Care Unit of the Cardiology Department.
The Cardiology Department Arrhythmia Unit treats heart rhythm disorders. It is responsible for diagnosis, treatment, research and training for all illnesses related to arrhythmias. These may be slow or fast. Slow arrhythmias often need a pacemaker to be fitted. Fast arrhythmias may cause the patient to lose consciousness, or even cardiac arrest.
The Arrhythmia Unit works closely with the Critical Cardiology Unit, the Adult Congenital Heart Disease Unit, and the Inpatient and Cardiac Surgery Areas. The Arrhythmia Unit was created in 1975. Since then it has expanded and specialises in various fields. The most important are as follows:
The Arrhythmia Unit has two theatres. One of them is completely dedicated to procedures such as:
The unit also has specific clinics to treat and monitor patients with cardiac arrhythmia. These include consultations about devices and five clinics dealing with the following matters:
In 2019, the unit carried out:
The Arrhythmia Unit works jointly with the Paediatric Cardiology Department on invasive treatment of cardiac arrhythmia in paediatric patients.
People can suffer from slow arrhythmia or fast arrhythmia. This often occurs in hearts affected by a cardiac disease, but also occurs in hearts with a normal structure.The most common fast arrhythmia is atrial fibrillation, which requires medical treatment and, occasionally, ablation with a catheter. This is a safe procedure and commonly gives good results.The most common slow arrhythmias are those that appear with age. They are caused by degeneration of the heart’s electrical system. They usually require a pacemaker to be fitted.
The Arrhythmia Unit also carries out common non-invasive procedures such as:
The Arrhythmia Unit has extensive experience in researching the field of cardiac arrhythmias. It has published many times in specialist journals. The following research lines are highlights:
The Arrhythmia Unit's team of professionals take active part in academic education and practical training on the medicine and nursing degree courses. Cardiology residents usually spend time at the unit, along with residents in other specialities at the hospital. Residents from other hospitals in the Vall d’Hebron area and from other Spanish, European and Latin American hospitals also do so, if they are interested in training on the treatment of arrhythmia diseases.
The unit's team regularly takes part in training activities outside the hospital. The unit offers the following specific, staff training courses periodically:
The Arrhythmia Unit has a coordinator and four assistants. They work with the nursing staff, consisting of seven specialist professionals, who deal with caring for patients and doing the invasive electrophysiology treatments. They also monitor patients with intracardiac devices on-site and remotely.
The Anaesthesia, Resuscitation and Pain Management Department provides comprehensive perioperative care for surgical patients, from their arrival to the hospital until they return home. We offer care with more than 30,000 operations a year.
At the Anaesthesia Department, our mission is to offer comprehensive perioperative care, from the moment the patient arrives at the clinic or hospital, during the operation and beyond.
We have a staff of professionals specialised in all areas, essential for the large number of transplants of all kinds that are performed at our Hospital. We should also mention our nursing team specialising in anaesthesia, who begin their career at our Department.
The Department is divided into four main geographical and care areas:
The Department encompasses several key working areas:
Outpatient preoperative consultations work with primary care in processes such as obstetrics and endoscopy labs. Preparatory and postoperative care are of vital importance in establishing a good flow of patients, especially in areas such as resuscitation.
Patients attended to by the Pain Unit have often been treated previously. This is due to the nature of their problem and the difficulty in solving the symptoms they suffer. This is why we have established fast-stream resolution and care schemes using a mobile application. Patients can inform us from their home of the degree of pain, thus improving their quality of life.
At the Neonatology Department, we are committed to offering personal, individualised care focussed on the development of the baby and encouraging family participation as a key element in the process.
At the Neonatology Department, part of the Maternity and Children's Hospital at Vall d'Hebron University Hospital, we are a reference centre for various techniques improving the lives of infants, such as: foetal therapy, ventilation needs and specific invasive respiratory assistance, surgical interventions and cardiac malformations. In addition, we use special blankets in the incubators that protect from noise and light, and we reduce the noise and level of lighting in the room. We aim to maximise the parents' participation in their baby’s care, in close collaboration with our nursing staff. We favour an open-door policy and promote skin-skin contact, or the kangaroo care method, for mothers and fathers, as well as breastfeeding.
Parents are welcome to enter the Neonatology Unit 24 hours a day to be with their child, and have a room available where meetings are also held so they can share experiences with other parents and staff from the Unit.
All this means we have been certified as a centre for NIDCAP training (Neonatal Individualised Development Care and Assessment Program), which promotes an active role for parents throughout the process, with support from staff from our Department.
We collaborate closely with the Obstetrics Department and other specialists and departments involved in providing care before and after discharge, in order to guarantee continuity of care. In this field, we can highlight three pioneering programmes at the national level: the Siblings Project, the "Almost like home" programme and the “Space to talk” programme.
We are structured into the following healthcare areas:
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The Paediatrics Teaching Unit has extensive experience in training specialists. There are a total of 60 Paediatrics residents at Vall d’Hebron University Hospital, 15 per year. Over the last few years, Paediatrics at Vall d’Hebron has been the first choice for new residents, and in the 2017 exam session achieved the best results of any Spanish hospital. In addition to this, we receive residents from hospitals all over the world.
Pediatric training itineraries
Over the last few years, paediatrics at Vall d’Hebron has been residents’ first choice, and in the 2017 exam session achieved the best results of any Spanish hospital.
The Department has a Paediatrics Teaching Subcommittee, comprising twelve tutors and twenty residents overseeing the practical application of the training and its integration into healthcare activities. Thanks to the involvement of these professionals, we can ensure supervised completion of the training programme objectives.
This Teaching Unit comprises different healthcare departments and units, including the Paediatrics, Nephrology, Neonatology, Paediatric Oncology and Haematology, Intensive Care, Neurology, Endocrinology, Infectious Diseases, Allergies, Cardiology, Respiratory Medicine, Gastroenterology, and A&E Departments.
It is vital for residents to train in research methodology as this is necessary to take part in and develop research projects. From the second year onwards, we invite residents to carry out research work, and a minimum number of papers and publications is required in addition to their full cooperation in sessions within the Department.
Why specialise at Vall d’Hebron?
The Neurosurgery Teaching Unit is led by the Neurosurgery Department, with participation from Neurology, Pathological Anatomy, Clinical Neurophysiology, Intensive Care and Neuroradiology.
Neurosurgery training itinerary
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