Journal of Neonatal Surgery | Year: 2022 | Volume: 11 | Page ID: 1 Improving neonatal surgical outcome: My vision Yogesh Kumar Sarin * President, Indian Association of Pediatric Surgeons & Emeritus Editor-in-chief, Journal of Neonatal Surgery. Correspondence*: Yogesh Kumar Sarin, Director Professor & Head Department of Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India. E-mail: yksarin@gmail.com I wonder if I, President of Indian Association of Pedi- atric Surgeons (IAPS), or Emeritus Editor-in-chief of Journal of Neonatal Surgery (JNS), am an authority to write about the measures that would improve out- comes in surgical neonates, but my vast experience, both as a neonatal surgeon and a hospital adminis- trator, has given me some insight in the issue and I humbly share it here. I must acknowledge that my learned friend, Prof. V Raveenthiran has provided substantial inputs. At the outset, let us admit that the outcomes in surgical neonates depend not only on the skill of the pediatric surgeon but also on that of a large team consisting of a pediatrician, anesthetist, radiologist, pathologist, biochemist, nurses, and oth- ers necessary for dealing satisfactorily with the new- born subjected to surgery. Allow me to enumerate the Ten Commandments 1. Exclusive pediatric anesthesia team 2. Safe transport to tertiary centers 3. Inclusion of congenital anomalies under all insurance schemes 4. Instruments and medical equipment specially designed and manufactured for neonatal usage must be made available, e.g., central lines, etc. 5. Collaboration with the neonatologists 6. Peri-operative care in Surgical NICU manned by the qualified pediatric surgeon(s) 7. Audit of neonatal deaths 8. Rotating MCh postgraduates in NICU for 1-2 months during their training period 9. Strict guidelines of the infection control committee 10. A dedicated nursing team that should not be rotated to other wards 1. Exclusive pediatric anesthesia team Perioperative morbidity and mortality in surgical neonates are 2-3 times higher as compared to older children and adults in our subcontinent. The anatomical, physiological, pharmacokinetic, and pharmacodynamic variations and presence of congenital cardiac, pulmonary and metabolic diseases in neonates make perioperative management challenging. [1] Pediatric and neonatal surgery as a specialty has been in existence in India in tertiary training institutes for more than 50 years. Likewise, neonatology and neonatal intensive care facilities have also been established since long. Administering safe anesthesia to a sick surgical neonate is dependent to the greatest extent on the skill and experience of the anesthetist and to a much lesser extent on the techniques and agents selected. It is well known that children have better outcomes when anesthetized by trained pediatric anesthetists than when anesthetized by general anesthetists, [2] and it is inconceivable that we pediatric/ neonatal surgeons would be able to deliver optimal results without competent pediatric anesthetists. [3] Unfortunately, pediatric anesthesia services have failed to match up to the demand and it is only recently that training programs in pediatric and neonatal anesthesia have commenced at some centers in India; we have (National Medical Council) NMC recognized post- doctoral course (DM) in Pediatric Anesthesia running in two major autonomous government institutions and DM in Pediatric and Neonatal Anesthesia in another major public-sector medical college in Mumbai. Indian Association of Paediatric Anaesthesiologists that was founded in 2006 has now 739 members and has been responsible for starting Pediatric Anesthesia Fellowships in as many as 10 centers across India. Of course, there is still a huge gap between demand and supply, but there has been a good start in the right direction. The practice of pediatric anesthesia requires the use of a range of equipment suitable for children of all ages. This includes specialized pediatric equipment for the administration of general as well as regional Editorial © 2022, Sarin YK Submitted: 01-01-2022 Accepted: 02-01-2022 License: This work is licensed under a Creative Commons Attribution 4.0 International License. DOI: https://doi.org/10.47338/jns.v11.1053