Assessment of Predictors of Mortality in Neonatal Intestinal Obstruction

Abstract

Background: Neonatal intestinal obstruction (NIO) continues to be a life-threatening condition with high mortality rates especially in developing countries. Highly skilled specialized care and facilities are required for survival. This study was conducted to assess various factors responsible for outcome in such neonates, so that extra attention is paid to the ones at high risk, with the idea to bring down the mortality rates in neonates admitted with intestinal obstruction.Materials and Methods: This study was a prospective observational study conducted on all neonates admitted with features of intestinal obstruction in our hospital from February 2014 to August 2016. The patients were followed up for a minimum of 1 month. Data was collected on prescribed proforma and analyzed for age, sex, prematurity, birth weight, clinical features, duration of symptoms, diagnosis, lab investigations, surgical procedure performed, complications etc. using the Statistical Package for Social Sciences (SPSS).Results: There were 120 neonates with intestinal obstruction, of which 92 neonates survived and 28 died. The mortality rate was 23.33%. There were 74 males and 46 females. The mean gestational age was 38.2±1.77 wks with a range between 32 to 41 wks. The mean age at presentation was 5.58 days with a range between 5 hrs to 26 days. The mean weight at presentation was 2510g. Mean duration of symptoms was 3.40 days. Gross congenital anomaly was seen in 22 neonates. Sepsis on admission was noted in 51 patients out of whom 23 died. Twenty-two patients presented with perforation peritonitis, of which 14 expired. Fifty-four neonates experienced significant in-hospital delay in surgery. The mean duration of stay in the hospital was 8.40 days. Overall, 92 neonates were discharged from the hospital.Conclusion: Neonatal intestinal obstruction is still associated with high mortality. After analyzing various factors we conclude, that increased age at presentation, delay in seeking treatment after the onset of symptoms, CRP/ blood culture positive sepsis on arrival, thrombocytopenia, acute kidney injury (raised urea and creatinine), acidosis and coagulopathy on admission, bowel perforation with peritonitis and the need for continued mechanical ventilation after surgery were the statistically significant risk factors for mortality in neonates with NIO in our series. However, sex, mode of delivery, gestational age, weight at presentation, hypothermia on arrival, associated gross congenital anomalies, delay in surgery after admission (in-hospital delay) and duration of stay in hospital were found to be statistically insignificant risk factors for mortality in our series.