<![CDATA[We report  one female  newborn baby suffered from  moderate asphyxia, meconium aspiration syndrome, and Hirschsprung  disease.  The  patient  admitted  in  Neonatal  Intensive  Care  Unit  (NICU)  and  ventilated  with Pressure Controlled Mandatory Ventilation (PCMV)  mode ventilator.  Patient suffered from  pneumodiastinum and therefore  mediastinotomy was performed. Sepsis and Necrotizing Enterocolitis (NEC)  made the  case more  complicated.  On  further  examination,  abdominal  was  distended  and  perforated  and  therefore  we decided  to  perform  exploration  laparatomy  and  sigmoidoctomy .  Anaesthesia  management  with  general anaesthesia  had  been  performed.  Premedication  was  not  given.  We  used  oxygen  and  Sevofluran  for induction;  Oxygen, Sevofluran, Atracurium, Fentanyl,  and  Morphin for  maintenance; and  Morphin for  post operative analgesic. On follow up examination, we found wound disruption and therefore relaparotomy was performed.  T ypes  and  doses  of  anesthesia  drugs  were  chosen  according  to  newborn  immature  organ  noticely . Providing adequate oxygenation, preventing hypotermi, and balancing electrolytes and acid base states still be the  most considerations in  management of this  patient.  Anesthetic management and intensive  care of this patient  gained  a  satisfying  outcome.  The  prognosis  was  good. Keywords:  Hirschsprung  disease,  meconium  aspiration  syndrome,  pneumomediastinum,  sepsis,  NEC.]]>
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