Abstract
Background: Neonatal surgery is still a challenge in developing country due to lack of appropriate equipment, inadequate work force and lack of political will by hospital management. However, there has been significant improvement in outcome over the last century. Objective: This study evaluates neonatal surgery in commercial city of Aba South East Nigeria with emphasis on challenges and management outcome. Methods: Prospective analysis of sixty neonates who had operative treatment at Abia State University Teaching Hospital Aba from October 2016 to July 2018. Proforma was opened for sex, weight, prenatal care, age at presentation, duration of symptoms prior to presentation, surgical pathology, treatment offered, associated congenital anomaly, evidence of prenatal diagnosis, complications and outcome. Results: There were 40 males and 20 females, male to female ratio of 2:1. The mean weight of the neonates was 2.5kg (range1.1-4.3kg). The average age at operation was 3 days (1-15days), the mean duration of symptoms before presentation was 3.5days. The major indication for operation was anorectal malformation 32 patients {53.3%} anterior abdominal wall defect 8 patients {13.3%}, Intestinal atresia 8 patients {13.3%}, intestinal perforation 8 patients {13.3%}, obstructed hernia 4 patient {6.6%}/There was associated congenital abnormality in 5 patients {8.3%} and prenatal diagnoses was made in 10 cases {16.6%}. During a mean follow up of 3months {1week to 9months, procedure related complications in 16 patients {26.6%} and 8patients died {mortality of 13.3%}. Conclusion: Surgical care of the neonate with a wide range of pathologies is still major challenge in our setting. Good political will, capacity building in form of manpower development and procurement of appropriate equipment will enhance the outcome.
Highlights
Paediatric surgery is a relatively young specialty whose rapid growth has largely been due to the development of neonatal surgery
Neonatologist, cardiologist, surgeon as well as Obstetrician will counsel in detail to ensure optimal care for mother and child. [1, 2] The counseling will ensure parents are fully prepared for eventual outcomes and events after delivery
We reviewed all neonatal surgical cases that was managed at the Abia State University Teaching Hospital Aba, a tertiary institution in the South East Nigeria with the aim of determining the challenges and management outcome
Summary
Paediatric surgery is a relatively young specialty whose rapid growth has largely been due to the development of neonatal surgery. [1, 2] The counseling will ensure parents are fully prepared for eventual outcomes and events after delivery. For a child with suspected complex anomalies, a tertiary setting is preferred for optimal neonatal care. For a child with suspected surgical problems, delivery obviously is better done in a setting with neonatal surgical and anesthetic expertise. Neonatal surgery is still a challenge in developing country due to lack of appropriate equipment, inadequate work force and lack of political will by hospital management. Proforma was opened for sex, weight, prenatal care, age at presentation, duration of symptoms prior to presentation, surgical pathology, treatment offered, associated congenital anomaly, evidence of prenatal diagnosis, complications and outcome. Conclusion: Surgical care of the neonate with a wide range of pathologies is still major challenge in our setting. Capacity building in form of manpower development and procurement of appropriate equipment will enhance the outcome
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