Neonatal surgery: Demand and survival both are on increase- an experience of seventeen years in Dhaka Medical College Hospital, Bangladesh

Abstract

Purpose: In order to achieve the Sustainable Development Goal (SDG) 3 target of reduction in under-five mortality below 25 per thousand live birth by the year of 2030, major reductions are going to be required in neonatal mortality. Congenital anomalies have become the fourth cause of neonatal deaths and most of these are curable. The largest public hospital of Bangladesh is serving the poor and lower middle class people where surgery and medical facilities are mostly free of cost. This study was done to see the types of neonatal surgical patients admitted in this hospital and their management out come with limited facilities and find out some new ideas and information and the ways to improve the scenario to contribute in achieving the SDG 3.
 Materials & Methods: This was a descriptive study with retrospective record review of all admitted neonates done over a period of 17 years from July 2001 to June 2018 and carried out in the Department of Pediatric Surgery. A total of 2492 neonates were admitted during this period and it was the 16.16% of total number of 15414 pediatric surgical admission upto12 years of age. Data was collected from hospital records and analyzed retrospectively. Detail history of each patient was collected and recorded in a pre-designed, semi-structured questionnaire. Statistical assessments were done by SPSS version 22. An Ethical clearance had been sought.
 Results: Out of these 2492 neonates, 1932 (77.53%) were admitted for Neonatal Intestinal Obstruction (NIO) and Intestinal atresia 246 (09.87%), Omphalocele 163 (06.54%), Meconium ileus 154 (06.18%), Volvulous neonatoram 125 (05.02%), Septicemia 114 (04.57%), Posterior urethral valve 78 (03.13%), Gastroschisis 75 (03.01%), Abscess 57 (02.29%), Congenital Diaphragmatic Hernia 54 (02.17%), Ectopia vesicae 50 (02.01%), Infantile pyloric stenosis 42 (01.68%), Tracheo-oesophageal fistula 24 (0.96%), Prune belly syndrome 8 (0.32%), Neonatal injury 5 (0.20%), Conjoint twin 4 (0.16%). The most common cause of NIO was anorectal malformation (ARM) 806 (32.34%). Among them 516 (64.02%) patients had high variety and 290 (35.98%) patients had low variety ARM. Next was Hirschsprungs disease and 487 (19.54%) neonates presented with this. One hundred and forteen (4.57%) patients presented with septicemia and 246 (9.87%) presented with intestinal atresia, 154 (6.18%) neonates had meconium ileus and 125 (5.02%) patients presented with volvulus neonatorum. Total 1791 (71.86%) patients were managed surgically. Most of the surgerical procedures were pelvic colostomy 541 (21.71%), transverse colostomy and biopsies 376 (15.09%), resection and anastomosis 261(10.47%), anoplasty 239 (9.59%), primary repair 135 (5.42%) and ileostomy 104(4.17%). Out of 2492 patients, 351 died, so mortality was 14.09%, before surgery 127 (5.10%) and after surgery was 224 (14.85%).
 Conclusion: Pediatric surgeons by their skill and teamwork greatly improved the neonatal surgical service and contributing significantly in reducing infant mortality rate to achieve SDG 3. But to improve further, neonatal intensive care unit (NICU) and other support systems are essential as well as support from UNICEF and World Health Organization (WHO) to include pediatric surgery and surgeons in their activities especially in developing countries. Due to socio-political and economic reasons of the developing countries the roll of pediatric surgeons are multidimensional.
 Bangladesh Med Res Counc Bull 2020; 46(1): 05-11

Neonatal Surgical Morbidity and Mortality at a Single Tertiary Center in a Low- and Middle-Income Country: A Retrospective Study of Clinical Outcomes

“…The mortality rate in this study is close to the reports published from two other high-volume centers of the country, which reflects the similarity in the neonatal surgical setups ( 7 , 8 ). Though data are not available, we can assume that the situation is worse in smaller centers.…”

“…The most common diagnoses of the expired babies were Anorectal Malformation (ARM) and Gastroschisis; this might be due to the higher incidence of these anomalies in this region. Reports from other institutes of Bangladesh and India reflect this fact (7,8,15). The highest percentage of babies died with Gastroschisis and Esophageal atresia.…”

“…More than 62,000 neonates die here every year ( 11 ). The contribution of neonatal surgery in this mortality is unknown, but clearly, the burden is increasing ( 7 , 8 ). Despite this rise, neonatal surgery fails to receive enough attention and importance in health care policies and surgical neonates remain the most neglected cohort during policy-making.…”

“…When poverty is one of the dominant factors contributing to this enormous burden, the treatment of these children makes the situation worse. This vicious cycle of poverty and insufficient health care facilities for surgical neonates results in a substantial difference the outcome of neonatal surgery between high-income and low-middle-income countries (1)(2)(3)(6)(7)(8). The data available are only based on inpatient admitted babies.…”

“…The actual data regarding neonatal surgical patient load in Bangladesh is not available, but this burden is increasing and contributing significantly to the causal list of neonatal mortality. Optimum surgical care could avoid at least twothirds of this mortality (5,(7)(8)(9)(10). United Nations sustainable development goal (SDG-3) targets to end preventable neonatal death by the year 2030 (11).…”