Outcome of neonatal surgeries in Nnewi, Nigeria

Abstract

Background: A surgical neonate is a challenge, especially in developing countries such as Nigeria, where neonatal surgical practice is still evolving. Mortality is still high compared with developed nations. Data from developing countries on this emerging aspect of paediatric surgery, however, are scarce. We reviewed all neonatal surgical cases that were managed at the Nnamdi Azikiwe University Teaching Hospital Nnewi, a tertiary institution located in the South Eastern region of Nigeria, with a view of determining the outcome.

Patients and methods: This was a retrospective review of Hospital records of infants aged 0–28 days who were treated at the Special Baby Care Unit of the hospital from January 2009 to June 2012.

Results: Out of 1863 babies admitted to the Special Care Baby Unit of the hospital, 147 (8%) were surgical cases. There were 91 males and 56 females (M: F=1.6 : 1). The mean weight of the babies was 2.5 kg (range=0.1–4.3 kg). Thirty-two babies (16.9%) were premature. The most frequent indication for admission is gastrointestinal conditions, accounting for 78.2% of all neonatal surgeries. The most common procedure carried out was intestinal anastomosis and repair (36%). One hundred and thirteen neonates (76.9%) presented beyond 48 h of onset of symptoms. Of the delayed cases, 65% sought medical attention early at the primary and secondary health centres, but referral was delayed from periods ranging from 2 to 21  days (mean=5 days). Only 15 of the neonates had a valid prenatal ultrasound diagnosis. In only three of the cases were the mothers referred for planned delivery and specialist care. Infective conditions (sepsis, surgical site infection, respiratory tract infections) accounted for 45.4% of morbidity. Mortality was higher in the late presenters, premature babies, babies with weight less than 2.5 kg and in thoracic surgeries. Overall, 41 neonates died, yielding a mortality of 27.9%.

Conclusion: The high morbidity and mortality from neonatal surgeries still persists. Factors that negatively affect the outcome include late presentation, prematurity, low birth weight and thoracic surgeries. Enhanced prenatal diagnosis,
early patient referral, further personnel training and improvement in facilities will improve outcome.

Keywords: late presentation, mortality, neonatal surgery, Nigeria, outcome