Management of Nigerian neonates with high-risk esophageal atresia: early versus delayed repair

Adeyemi, S. Debo

doi:10.1007/bf00181837

Cited by 5 publications

(12 citation statements)

References 12 publications

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“…These findings agreed with similar studies in this subregion. [10][11][12][13] They were, however, at variance with results from developed countries where no significant statistical difference was observed when postoperative wound infection was compared between gastrointestinal and extra-gastrointestinal surgeries, and where prematurity was the major factor that increased the risk of postoperative wound infection and sepsis. [1,4,[15][16][17] The risks of postoperative wound infection and sepsis are increased at the extremes of age, the neonatal period being a stage of immune compromise.…”

Section: Discussioncontrasting

confidence: 75%

“…[1,14] Overall rates recorded in this study for postoperative wound infection 11.8%, sepsis 9.9% and sepsis-related deaths 3.7% approached reports from studies in developed countries despite the unique challenges. [1,4,9] This could be attributable to adequate culture and sensitivity testing that influenced combinations of antibiotics which gave the best coverage against bacteria earlier reported [2,6,[10][11][12][13] as major causes of neonatal sepsis and postoperative wound infections in this subregion. Although wound infection and sepsis were commonly associated with gastrointestinal and cardiothoracic surgeries, and among babies delivered outside the study centres, there were no significant statistical differences observed when wound infection and sepsis were compared between preterm and term neonates.…”

Section: Discussionmentioning

confidence: 94%

“…Such opportunistic organisms are usually resistant to many antibiotics most commonly used for perioperative prophylaxis in neonates as seen in this and other similar studies. [1,2,6,[10][11][12][13] Moreover, immune compromise in these neonates helped in the establishment of polymicrobial infections that were notable challenges in this study. The challenges were compounded by late referral and delayed treatment of affected babies, especially those delivered outside the study centres.…”

Section: Discussionmentioning

confidence: 95%

“…[2,6,[10][11][12][13] Therefore, knowledge of adequate combinations of antibiotics that give the best outcome is important when managing surgical neonates in sub-Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

“…[4,9] Although the incidence of sepsis is low in many sophisticated centres, postoperative wound infection and sepsis are, nonetheless, still major causes of mortality and morbidity that increase the length of hospitalisation and cost of treatment in sub-Saharan Africa. [10][11][12][13] This is because of poor obstetric care, delivery in unhygienic environment and septic handlings of the newborns.…”

mentioning

confidence: 99%

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Audit of antibiotic therapy in surgical neonates in a tertiary hospital in Benin City, Nigeria

Osifo

Aghahowa

2011

Afr J Paediatr Surg

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Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 95%

“…[2,6,[10][11][12][13] Therefore, knowledge of adequate combinations of antibiotics that give the best outcome is important when managing surgical neonates in sub-Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Audit of antibiotic therapy in surgical neonates in a tertiary hospital in Benin City, Nigeria

Osifo

Aghahowa

2011

Afr J Paediatr Surg

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Esophageal atresia: Factors influencing survival - Experience at an Indian tertiary centre

Tandon

Sharma

Sinha

et al. 2008

J Indian Assoc Pediatr Surg

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Objective:To study the clinical profile of the cases of esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) and various factors affecting the surgical and early postoperative management and their outcome.Materials and Methods:A prospective analysis of 127 cases of EA from February 2004 to May 2006 was performed. Waterston prognostic criteria were used for grading.Results:EA with TEF was the commonest type in 117 cases (92%). Associated congenital anomalies were present in 52 (41%) patients, the commonest being the cardiac anomalies, which was followed by the gastrointestinal anomalies. VACTERL was found in 6 (5%) cases. Prematurity, associated congenital anomalies, gap between esophageal ends and preoperative respiratory status were the significant factors affecting the survival (P = < 0.001). Primary extrapleural repair was the surgical approach in most of the patients. Azygos vein was preserved in 46 cases and no retropleural drainage was used in 27 cases. Staged procedures were performed in 19 cases, including 6 cases of isolated esophageal atresia. Pneumonitis and sepsis were the most common early postoperative complications (42%). Hypoxia and cardiorespiratory arrest were the most common causes of mortality (11 cases). Anastomotic leak complicated 13 cases, including 9 major and 4 minor leaks. Major leak followed by sepsis caused 7 deaths. Survival as per Waterston criteria was 100% in group A, 83% in group B and 22% in group C.ConclusionFactors affecting the survival are major or life-threatening associated anomalies, long gap, pneumonia and sepsis at presentation or that acquired during hospitalization and major leaks. The high incidence of low birth weight, delayed diagnosis, poor referral, low-socio economic status and lack of advanced neonatological back up are important contributory factors to poor outcome.

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Successful Management of Oesophageal Atresia in Cameroon, Sub-Saharan Africa

Fola¹,

Jemea²,

Bayiha³

et al. 2023

African Journal of Paediatric Surgery

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Background: Oesophageal atresia (EA) is the most common congenital anomaly of the oesophagus. Despite improvement of survival observed over the previous two decades in developed countries, the mortality remains very high and the management greatly challenging in resource-poor settings such as Cameroon. We report our experience of management of EA in this environment, with a successful outcome. Materials and Methods: We prospectively assessed patients diagnosed with EA and operated in January 2019, at the University Hospital Centre of Yaounde. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures and outcomes. The study has received approval from the Institutional Ethics Committees. Results: In total, six patients (three males and three females, sex ratio, 0.5; mean age at diagnosis, 3.6 days; range, 1–7 days) were assessed. A past history of polyhydramnios was found in one patient (16.7%). All patients were classified Waterston Group A at diagnosis, with Ladd-Swenson type III atresia. Early primary repair was performed in four patients (66.7%) and delayed primary repair in two patients (33.3%). Operative repair mainly involved resection of the fistula, suture of trachea and oesophagus end-to-end anastomosis, followed by interposition of vascularised pleural flap. Patients were followed up 24 months. With one late death, the survival rate was 83.3%. Conclusion: Improvement has been achieved in the outcomes of neonatal surgery in Africa in the past two decades, but EA-related mortality remains relatively too high. Using simple techniques and available, reproducible equipment can improve survival in resource-poor settings.

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Management of Nigerian neonates with high-risk esophageal atresia: early versus delayed repair

Cited by 5 publications

References 12 publications

Audit of antibiotic therapy in surgical neonates in a tertiary hospital in Benin City, Nigeria

Audit of antibiotic therapy in surgical neonates in a tertiary hospital in Benin City, Nigeria

Esophageal atresia: Factors influencing survival - Experience at an Indian tertiary centre

Successful Management of Oesophageal Atresia in Cameroon, Sub-Saharan Africa

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