Preterm birth presents a serious medical challenge and a lasting problem of perinatal medicine for health systems in most countries around the world. Prematurely born infants are at birth physiologically immature and their metabolism is not completely developed, and often lack self-regulatory ability to respond appropriately to the outside word. Premature infants have a different frequency of prematurity-related illnesses depending on the gestational age, and their mortality is ten times greater than that of infants born in term. The morbidity associated with preterm birth frequently continues later in life and is often manifested in permanent damage to various organic systems, especially by neurodevelopmental disorders. The rate of premature births in Croatia is steadily increasing and is now about 6%. Continuous advance in perinatology and intensive care in newborns have contributed to reducing the consequences of premature birth, to greater survival of immature neonates, and also to the development of neonatal surgery which can successfully treat surgical diseases in low and very low birth weight neonates. The most common indications for surgical treatment of premature infants are acquired diseases associated with multiple organ insufficiency of prematurity: perforation due to bowel changes caused by ischemia or inflammation (necrotizing enterocolitis, spontaneous intestinal perforation), intestinal obstruction associated with functional dysfunction of the digestive tract and complications of inguinal hernia. Congenital anomalies in the group of premature births make about 30% of the indications for surgical treatment. Improvement in preoperative stabilization, anesthesiological procedures, surgical tehniques and postoperative treatment also result in improving the outcome of preterm infants' therapy. Such good treatment encourages changes in the procedures of diagnostic and therapeutic decision making in the treatment of preterm infants with surgical diseases.