The reality of neonatal surgery in Latin America and the Caribbean: Perspectives and opinions of pediatric surgeons

• Neonatal surgery in Latin America and Caribbean shows heterogeneity and inequities. • Most centers report low surgical volume and limited advanced resources. • No formal subspecialty programs. Only 20 % consider residency training sufficient. • Neonatal are often managed by general surgeons without specific neonatal training • Persistent challenges: underinvestment, weak registries, unequal access. Neonatal surgery in Latin America and the Caribbean (LAC) faces significant challenges due to regional disparities in resources and healthcare infrastructure. Although infant mortality rates have declined, congenital anomalies remain a leading cause of neonatal death. This study aimed to evaluate the current state of neonatal surgery across the LAC region. This cross-sectional, mixed-methods study comprised a 23-item online survey completed by pediatric surgeons from LAC and interviews with 10 representatives of regional pediatric surgery societies. Topics included care organization, infrastructure, training, referral networks, centralization, prenatal diagnosis, and barriers. Among 141 pediatric surgeons surveyed, most worked in medium- or high-complexity hospitals and reported low annual volumes of major neonatal surgery and limited formal centralization networks. Interhospital referrals were frequent (61 %). Although access to neonatal intensive care (94 %) and mechanical ventilation (84 %) was common, resources for minimally invasive surgery (35 %) and interventional radiology (29 %) were limited. While 76.5 % received neonatal surgery training during residency, only 19.9 % found it adequate. Interviews revealed geographic inequalities, poorly defined referral networks, variability in prenatal diagnosis, declining birth rates, inconsistent legislation on voluntary interruption of pregnancy, and a lack of registries. No country formally recognizes neonatal surgery as a subspecialty. Reported barriers included late referrals, resource shortages, and uneven distribution of specialists. Neonatal surgery in LAC is constrained by limited resources and restricted access to specialized care. Solutions require investment in infrastructure, standardized training, improved referral systems, and greater engagement of scientific societies to promote equitable, safe, and timely care.