MORTALITY RISK FACTORS FOR NEONATAL INTESTINAL OBSTRUCTION

Haithem Hussein Ali Almoamin

doi:10.33762/bsurg.2015.108133

Abstract

This study aimed to determine the type of neonatal intestinal obstruction, their mortality, and the significance of the direct causes of death. A retrospective study of all neonates managed for neonatal intestinal obstruction (total number studied was 161 child) at Basrah Children's Specialty Hospital (BCSH) between June 2012 and June 2014. Data were collected from patients’ hospital records (neonatal intensive care unit) and analyzed for age, sex, clinical features, diagnosis, surgical procedure performed, prematurity, birth weight, duration of symptoms, complications and their management. The mortality due to neonatal intestinal obstruction is still high in our setting (25.5%). The significant factors associated with mortality were prematurity, birth weight, sepsis; reoperation, short bowel syndrome, and proximal intestinal stoma. Certain causes of neonatal intestinal obstruction were associated with high mortality e.g. jejunoileal atresia (52.6%), meconium ileus (50%), perforated viscus (46%), and duodenal atresia. Male are affected more than female with M:F ratio of 2.4:1. The most common cause of intestinal obstruction in neonates in this series was anorectal malformations (33.5%). Other causes of neonatal intestinal obstruction included Hirschsprung’s disease (24.2%), small intestinal atresias (11.8%), intestinal malrotation with or without volvulus (9.3%), perforated viscus (8.1%), meconium ileus (7.5%), duodenal aresia (2.5%), annular pancreas (1.2%), and meconium plug syndrome, necrotizing enterocolitis and segmental dilatation (0.6%, each). In conclusion, neonatal intestinal obstruction is a common cause of admission accounting for 28.2% of all admission. Mortality from intestinal obstruction is still high in our society and strict measures regarding prenatal, natal and postnatal management should be addressed to save those neonates.

Highlights

Congenital intestinal obstruction occurs in approximately 1:2000 live births and is a common cause of admission to neonatal surgical units, accounting for up to one-third of all admissions[1]
A total of 572 neonates had admitted to the NICU various conditions, with neonatal intestinal obstruction (NIO) representing about 28.2% of the neonatal surgical conditions
Other causes of NIO include Hirschsprung’s disease in 39 (24.2%) patients, small intestinal atresias in 19 patients (11.8%), intestinal malrotation and volvulus in 15 patients (9.3%), perforated viscus in 13 (8.1%), meconium ileus in 12 (7.5%), duodenal aresia in 4 (2.5%) which is much less than that found in text[1], annular pancreas in 2 (1.2%), and meconium plug syndrome, necrotizing enterocolitis and segmental dilatation in 1 patient each (0.6%)

Summary

Introduction

Congenital intestinal obstruction occurs in approximately 1:2000 live births and is a common cause of admission to neonatal surgical units, accounting for up to one-third of all admissions[1]. Bilestained vomiting in the infant is a sign of intestinal obstruction until proved otherwise[2]. Prompt recognition and treatment of neonatal intestinal obstruction (NIO) can truly be lifesaving[3]. The mortality associated with NIO ranges between 21-45% in developing countries, unlike the less than 15% in Europe[4,6]. Some factors attributing to the high mortality in developing countries include prematurity, late presentation, associated severe congenital anomalies and complications of surgery as well as lack of neonatal intensive care facilities[4,7]

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Results

Discussion

Conclusion