title: Management of neonatal ovarian cysts and its effect on ovarian preservation.
abstract: OBJECTIVE
  Management of asymptomatic neonatal ovarian cysts varies. Some surgeons advocate initial observation, while others recommend immediate operation depending on cyst size and complexity. This study aims to compare outcomes of initial observation versus primary surgery, focusing on incidence of postnatal torsion and ovarian preservation.
  
  
  METHODS
  A retrospective study (1997-2012) of neonates with an ovarian mass was performed. Data on cyst size, ultrasound characteristics, clinical course, complications, and pathology were extracted.
  
  
  RESULTS
  Thirty-seven neonates with asymptomatic ovarian cysts were identified (N=25 observed, N=12 primary surgery). Overall, 12/25 (48%) observed had successful cyst regression, including 3/8 (38%) cysts ≥50mm and 6/15 (40%) complex. 13/25 patients (52%) underwent surgery for failure of cyst regression (11/13) or concern for interval torsion (2/13). Postnatal torsion occurred in 1/25 observation patients (4%), or 1/8 (13%) with cysts≥50mm. Overall rate of ovarian preservation between groups was not statistically different [6/8 (75%) observed versus 8/9 (89%) primary surgery; P=0.577]. Pathology found viable ovarian tissue in all oophorectomy specimens (N=3).
  
  
  CONCLUSIONS
  Postnatal torsion is rare. A period of observation spares half of neonates from an operation, without decreasing ovarian salvage. Initial management should consist of observation, regardless of size or complex characteristics. If operative intervention is necessary, ovary preserving techniques should be utilized.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, J W Riley Hospital for Children, Indianapolis, IN, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Papic
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, J W Riley Hospital for Children, Indianapolis, IN, USA.
authors.forename: Deborah F
authors.initials: DF
authors.lastname: Billmire
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, J W Riley Hospital for Children, Indianapolis, IN, USA.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Rescorla
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, J W Riley Hospital for Children, Indianapolis, IN, USA; Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: S Maria E
authors.initials: SM
authors.lastname: Finnell
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, J W Riley Hospital for Children, Indianapolis, IN, USA. Electronic address: LEYS@surgery.wisc.edu.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Leys
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D010048:Ovarian Cysts / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
keywords: Neonate; Ovarian cyst; Ovarian preservation; Ovarian salvage