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

Abstract

BackgroundThe most challenging and demanding issue in Pediatrics and Pediatric Surgery is to deal with neonatal surgery which almost always involves emergency neonatal surgical conditions. Emergency neonatal surgery most often involves congenital anomalies. More than 90% of these anomalies occur in low- and middle-income countries (LMICs) like Bangladesh. This considerable load of patients and inadequate resources in their management continue to be an unconquerable challenge for pediatric and neonatal surgeons in this region. We aim to review the challenges and constraints influencing the outcomes of emergency neonatal surgery which will guide to propose expectations from the global community.MethodWe reviewed hospital records of neonates admitted to a tertiary care pediatric hospital between January 2016 and December 2020. Demographic and clinical data were extracted using a questionnaire and analyzed using SPSS 25.ResultsA total of 3,447 neonates were admitted during the five-year study period. More than 80% of the patients had at least one prenatal ultrasonography (USG) scan, but less than 10% had a prenatal diagnosis. More than 70% of the anomalies of the patient involved the gastrointestinal tract and abdominal wall. Overall mortality was an alarming 14.6%. Gastroschisis (>90%) and esophageal atresia (>85%) mainly contributed to this high mortality. The challenges detected in this review were the absence of a prenatal diagnosis, limited access to intensive care facilities, unavailability of parenteral nutrition, inadequate monitoring, and hospital-acquired sepsis.ConclusionEmergency neonatal surgery contributes to a significant proportion of neonatal mortality. A holistic approach is essential to improve the situation, including the infrastructure and human resource development, identification of causes, and implementation of preventive measures to reduce the patient load. Global collaboration remains to be a vital factor to mitigate these multifactorial constraints.

Pattern and outcomes of neonatal surgical patients in an Ethiopian Tertiary Hospital

“…The mortality rate in the Nigerian study was high because it focused only on emergency neonatal surgical conditions and Manchanda's report showed that the predominant cases operated on were esophageal atresia which has consistently higher fatality rates across facilities(18, 27, 28). Postoperative mortality among surgically managed neonates was 20.6%, which is much higher than the Bangladesh studies' gure of approximately 9 and 14.3% (5,29).…”

Pediatric perioperative mortality in Southeastern Nigeria—a multicenter, prospective study

“…[18] Neonates accounted for the majority (60.7% ) of deaths, mirroring Ademola et al's nding of 58.8% [12] Neonates encounter distinct challenges as they transit from intrauterine life to postnatal life, and going through surgery can disrupt this delicate balance, making them more vulnerable to sepsis, nutritional de ciencies, and respiratory problems. [19]The neonatal surgical mortality (NSM) rate was 19.8%, lower than reports from India (33.33%), [17] Bangladesh (14.6%), [20] and Tunisia [21] but higher than those from HICs. [14,[22][23][24] The lower neonatal mortality rates in HICs have been linked to advanced perioperative support systems, prenatal diagnosis, improved perinatal care, availability of NICUs, and TPN.…”

The Outcome of Different Surgical Conditions in Neonates at A Tertiary Care Hospital: A Cross-Sectional Study

“…However the other hidden contributors are the surgical conditions which are usually not high achieved united nation's sustainable goal (SDG-3) target of resource-limited neonatal deaths the by the year 2030, will not be achieved without improving surgical care for neonates, in resourcelimited places. 4,6 Even when the antenatal diagnosis is made of a congenital anomaly (if the facility was available), there is the longterm psychological impact on the expectant parents and family. The hopes and dreams of parents are overwhelmed with fear of the long-term morbidity of death.…”

“…3 Prolonged duration of operation, blood loss during surgery and hypothermia during or after surgery can worsen the outcome. 4 In economically poor countries neonatal mortality is still high in comparison to developed countries because of access to prenatal diagnosis and scarcity of trained personnel. Set up for Neonatal surgery and care in Pakistan is fair in a few centers, in some cities but in most of the centers it is still considered a challenge and needs a lot of work to improve the facilities.…”