Abstract
Background: Neonatal surgical conditions account for 11% of the Global Burden of Diseases (GBD); neglect of their management has been reported though most are amenable to surgery. Timely surgical interventions play a major role in determining better outcomes, thus improving quality of life and reducing disability. Several factors—sepsis control, care in newborn intensive care unit and availability of total parenteral nutrition—have been shown to improve the outcomes of neonates with surgical conditions. Objective: To evaluate the outcomes of neonates with conditions requiring surgical interventions. Methods: A prospective descriptive study in the Newborn Unit, Moi Teaching and Referral Hospital (MTRH). Data on the following study variables were obtained and analyzed: maternal age, place and mode of delivery, newborn’s age at admission, birth weight, surgical condition, co-morbid conditions, treatment outcomes (discharge, death or referral to Kenyatta National Hospital for specialized care), surgical complications, time-to-initiation of oral feeds post-operatively, antenatal history and laboratory parameters; and length of hospital stay. Results: A total of 124 neonates were recruited; male to female ratio was 1.1:1 and median age at admission was 2 days (IQR 1, 5). Most (59.7%) were in the birth weight range of 2.5–3.9 kg. The leading neonatal surgical conditions were gastroschisis 33(26.6%), neural tube defects 25(20.2%) and ARM 25(20.2%). Overall mortality rate was 31.5%. Antenatal clinic attendance was associated with decreased odds of mortality (OR 0.126; 95% CI 0.025–0.6429; p=0.013), while neonatal sepsis, respiratory distress and electrolyte imbalance were associated with increased odds of mortality ([OR 3.4; 95% CI 1.09–22.06; p=0.049], [OR 4.9; CI 0.91–11.61; p=0.001] and [OR 3.1; CI 1.21–31.60; p=0.029], respectively). Conclusions: The overall mortality rate of neonates requiring surgical interventions at MTRH was 31.5% and the median length of hospital stay was 14.5 days. Co-morbid conditions that increased the odds of mortality among these neonates were neonatal sepsis, respiratory distress and electrolyte imbalance. Keywords: Neonates, Surgical, Interventions, Outcomes
Highlights
The World Health Organization defines a neonate as child less than 28 days of age, a critical period during which the child is at the highest risk of dying [1]
During the study period 1,096 neonates were admitted to the unit: neonatal surgical conditions accounted for 11.3%
Routine antenatal ultrasound scans were done on Bivariate analysis showed a significant association between only 4% of the mothers and no congenital anomaly was the presence of co-morbid conditions and mortality, p=0.001, (Table 2)
Summary
The World Health Organization defines a neonate as child less than 28 days of age, a critical period during which the child is at the highest risk of dying [1]. Successful management of neonates with surgical conditions requires a multidisciplinary approach, especially in postoperative care Factors such as sepsis control, care in the newborn intensive care unit (NICU) and availability of total parenteral nutrition (TPN) have been shown to improve the outcomes. Neonatal surgical conditions account for 11% of the Global Burden of Diseases (GBD); neglect of their management has been reported though most are amenable to surgery. Data on the following study variables were obtained and analyzed: maternal age, place and mode of delivery, newborn’s age at admission, birth weight, surgical condition, co-morbid conditions, treatment outcomes (discharge, death or referral to Kenyatta National Hospital for specialized care), surgical complications, time-to-initiation of oral feeds post-operatively, antenatal history and laboratory parameters; and length of hospital stay. Conclusions: The overall mortality rate of neonates requiring surgical interventions at MTRH was 31.5% and the median length of hospital stay was 14.5 days. Co-morbid conditions that increased the odds of mortality among these neonates were neonatal sepsis, respiratory distress and electrolyte imbalance
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