The continuous improvement in the quality of modern perinatology, sociodemographic changes and the increasing spread of reproductive medicine have resulted in an increasing number of premature infants to be treated. The treatment of preterm infants (< 37th week of pregnancy) and especially extremely premature infants (< 28th week of pregnancy) is challenging due to immature organ development, which differs considerably from that of other age groups. While the fate of premature infants and especially extremely premature infants was unfavorable 100 years ago, the survival of premature infants > 1000 g has now shifted to survival in over 80% of cases [30]. The main medical problem areas of immature patients are a fetal proinflammatory immune system, an immature gastrointestinal tract with reduced transport capability, an incompletely developed intestinal barrier and a developing intestinal flora (microbiome) as well as immature lungs, which was significantly limiting for the survival of premature infants before the development of synthetic pulmonary surfactants. Furthermore, the central nervous system (CNS), which is far from being fully developed in preterm infants, is particularly vulnerable to exogenous factors, such as inflammation, toxins and medications. In addition, the CNS requires an environment appropriate to the developmental stage of the neonate to ensure normal physiological psychomotor development in the future. The article presents the special aspects of surgery on premature infants, the indications, complications and outcome, taking the special general problems of prematurity into account. Finally, the ethical conflicts associated with the care of extremely premature infants are briefly discussed.
