Neonatal Surgical Emergencies and Congenital Anomalies — WACS Viva & Clinical Scenarios (Paediatrics & Day Care)

Exam-style neonatal surgical emergencies and congenital anomalies viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 12-hour-old term neonate weighing 2.8 kg presents with severe respiratory distress, cyanosis, scaphoid abdomen, and bowel sounds audible in the left hemithorax. Pre-ductal SpO₂ is 84% on 100% oxygen via headbox, and post-ductal SpO₂ is 68%. How do you prepare, resuscitate, induce, and manage anaesthesia for this neonate scheduled for urgent repair of a congenital diaphragmatic hernia?
• SCENARIO 2: A 36-hour-old neonate weighing 2.4 kg is diagnosed with Gross Type C oesophageal atresia with distal tracheo-oesophageal fistula. The abdomen is distended with air, and there are bilateral coarse crepitations. Outline your anaesthetic plan, specifically detailing airway management, positioning of the endotracheal tube relative to the fistula, ventilation strategy, and avoidance of catastrophic gastric distension.
• SCENARIO 3: A 4-hour-old neonate weighing 2.1 kg is brought to the emergency theatre with an intact large omphalocele. During primary fascial closure under general anaesthesia, the peak inspiratory pressure rises from 16 cmH₂O to 34 cmH₂O, heart rate drops from 150 bpm to 95 bpm, and SpO₂ drops from 98% to 82%. How do you evaluate and manage this intraoperative crisis?
• SCENARIO 4: A 3-day-old preterm neonate (gestational age 31 weeks, weight 1.3 kg) in the neonatal intensive care unit develops Bell Stage III necrotising enterocolitis with abdominal distension, severe metabolic acidosis (pH 7.10, base deficit -14 mmol/L), thrombocytopenia, and gross pneumoperitoneum. Detail your anaesthetic management for an emergency exploratory laparotomy and bowel resection.