What is Neonatal & Pediatric Thoracic and Chest Surgery?

Neonatal and pediatric thoracic surgery addresses conditions affecting the chest, lungs, esophagus, diaphragm, and chest wall in newborns, infants, children, and adolescents. These conditions range from life-threatening congenital abnormalities requiring immediate intervention in newborns to acquired conditions in older children such as chest wall deformities or complications from respiratory infections. Our fellowship-trained pediatric surgeons at Western Surgical Group have specialized expertise in these complex procedures.

The chest cavity in children presents unique surgical challenges. Delicate lung tissue, a small working space, and the need to preserve growing structures require specialized surgical skills and equipment. We use Video-Assisted Thoracoscopic Surgery (VATS) whenever possible—a minimally invasive technique using tiny cameras and instruments inserted through small incisions. VATS offers excellent visualization while minimizing trauma to the chest wall, resulting in less pain and faster recovery.

Many thoracic conditions in newborns are diagnosed prenatally through ultrasound, allowing our team to counsel families and coordinate care before delivery. Others present with breathing difficulties, feeding problems, or recurrent respiratory infections. Whether treating a life-threatening neonatal emergency or a teenager with chest wall deformity affecting self-esteem and function, we provide comprehensive, compassionate care tailored to each child’s specific needs.

Neonatal Thoracic Conditions

Congenital Diaphragmatic Hernia (CDH): A birth defect where a hole in the diaphragm allows abdominal organs to move into the chest cavity, preventing normal lung development. This life-threatening condition requires immediate surgical repair after birth to move organs back into the abdomen and repair the diaphragm, allowing lungs to expand properly.

Tracheoesophageal Fistula (TEF) and Esophageal Atresia (EA): Abnormal connections between the trachea (windpipe) and esophagus (food pipe), often with the esophagus ending in a pouch rather than connecting to the stomach. These conditions prevent normal feeding and cause respiratory problems. Surgical repair connects the esophagus properly and closes abnormal connections, typically performed within the first days of life.

Esophageal Stenosis: Narrowing of the esophagus that prevents normal swallowing. Treatment may involve dilation to stretch the narrowed area or surgical reconstruction in severe cases.

Congenital Lung Malformations: Abnormal lung tissue development including cystic adenomatoid malformation (CCAM), pulmonary sequestration, and congenital lobar emphysema. While some small lesions can be observed, others require surgical removal to prevent infection, respiratory compromise, or potential malignant transformation.

Tracheomalacia: Weakness of the tracheal walls causing collapse during breathing, leading to respiratory distress and difficulty clearing secretions. Severe cases may require tracheopexy—a surgical procedure to reinforce the airway and prevent collapse.

Pediatric Thoracic Conditions

Pectus Excavatum (Sunken Chest): The most common chest wall deformity where the breastbone is sunken inward. While mild cases may be observed, moderate to severe deformity can affect breathing, exercise tolerance, and self-image. The Nuss procedure—a minimally invasive technique placing a bar beneath the sternum to reshape the chest—is typically performed in teenagers with excellent cosmetic and functional outcomes.

Pectus Carinatum (Pigeon Chest): Outward protrusion of the breastbone. Treatment may involve bracing for younger children or surgical correction for severe cases or when bracing fails.

Empyema and Lung Abscess: Serious infections in the chest cavity or lung tissue, often complications of pneumonia. When antibiotics alone are insufficient, surgery removes infected material and allows the lung to re-expand. We typically use VATS for these procedures.

Spontaneous Pneumothorax: Collapsed lung occurring without major trauma, more common in tall, thin teenagers. Initial treatment involves chest tube placement, but surgery may be needed for recurrent pneumothorax to prevent future episodes.

Foreign Body Aspiration: When children inhale objects into the airway, emergency removal is necessary. While many foreign bodies can be removed using bronchoscopy, some require surgical intervention.

Chest Wall Masses and Venous Access: Surgical removal of cysts, tumors, or other masses in the chest, and placement of long-term central venous catheters for children requiring extended intravenous therapy.

Video-Assisted Thoracoscopic Surgery (VATS)

We perform many thoracic procedures using VATS, offering significant advantages:
  • Smaller incisions (typically 3-4 small ports vs. large chest incision)
  • Less post-operative pain and faster recovery
  • Reduced risk of chest wall deformity from surgery
  • Shorter hospital stays
  • Better cosmetic outcomes
  • Excellent surgical visualization with magnified camera views

What to Expect

For neonatal thoracic emergencies, surgery is performed as soon as your baby is stabilized, often within hours or days of birth. These procedures are done in specialized facilities with neonatal intensive care capabilities. Recovery involves mechanical ventilation support initially, with gradual weaning as the baby’s lungs mature and heal.

For older children, thoracic surgery is carefully planned. Pre-operative evaluation includes chest X-rays or CT scans, pulmonary function testing if appropriate, and a thorough physical examination. Most procedures require 2-5 days of hospitalization depending on complexity. Post-operative care includes chest tube management, pain control, breathing exercises, and gradual return to activities. We provide detailed instructions for home care and close follow-up to monitor recovery.

Divisions Involved in Your Care

Diagnoses We Treat

Frequently Asked Questions

The Nuss procedure corrects pectus excavatum by placing a curved metal bar beneath the sternum through small incisions on each side of the chest. The bar remains in place for 2-3 years while the chest wall remodels into the corrected position, then is removed in a second brief surgery. Initial recovery involves 3-5 days in the hospital with epidural or patient-controlled pain management. Most patients return to school within 2-3 weeks and resume full activity (including sports) after 3-6 months. Long-term results are excellent.

Many thoracic procedures require temporary chest tube placement to drain air or fluid and allow the lung to re-expand properly. Chest tubes are typically removed after 2-4 days once drainage decreases and X-rays show good lung re-expansion. While chest tubes can be uncomfortable, we manage pain carefully and the tubes are essential for proper healing. Once removed, children typically feel much better quickly.

This depends on the type, size, and location of the malformation. Some small lesions that are asymptomatic can be monitored with serial imaging. However, many pediatric surgeons recommend removal even for asymptomatic lesions due to infection risk, potential for growth, rare possibility of malignant transformation, and the fact that surgery is typically safer and easier in younger children before complications occur. We'll discuss the specific risks and benefits for your child's situation.

Surgical correction of pectus deformities has excellent success rates. For pectus excavatum, the Nuss procedure achieves good to excellent cosmetic results in over 95% of patients, with significant improvements in symptoms like exercise intolerance when present. Patient satisfaction is very high, particularly regarding improved appearance and self-confidence. Complications are relatively rare when surgery is performed by experienced pediatric surgeons.

CDH outcomes have improved significantly with advances in neonatal care and surgical techniques. Survival rates now exceed 70-80% at experienced centers. Long-term outcomes depend on the severity of lung underdevelopment and associated anomalies. Many survivors have normal or near-normal lung function, though some may have chronic respiratory issues, feeding difficulties, or developmental delays requiring ongoing support. Our team provides long-term follow-up care and coordinates with specialists as needed.

Recovery from VATS procedures is typically faster than traditional open thoracotomy. Most children stay in the hospital 2-4 days depending on the procedure. Pain is usually well-controlled with oral medications after the first day or two. Children generally return to school within 1-2 weeks and resume full activities including sports within 3-4 weeks. Specific restrictions depend on the procedure performed, and we'll provide detailed guidelines for your child's recovery.