Neonatal surgical mortality and morbidity at the University Teaching Hospital of Kigali, a tertiary university hospital in Rwanda: analysis of predicting factors

Abstract

INTRODUCTION: Globally, high morbidity and mortality is associated with neonatal surgical
conditions. This study aimed to determine the factors influencing the mortality in neonates with
surgical conditions at Centre Hospitalier Universitaire de Kigali (CHUK).
METHOD: This was a prospective study from October 2019 to March 2020. Analysis of patients
was divided based on a diagnosis of gastroschisis versus non-gastroschisis conditions. Odds ratios
were calculated at a confidence interval of 95%. Factors with p-value <0.05 on bivariate analysis
were considered.
RESULTS: Eighty-two neonates were enrolled. 45.1% were admitted within the first 24 hours of life,
61% were males, 26.9% were preterm, and 51.2% had birth weight less than 2500g. Gastroschisis
(n=43, 52.4%) was the most common diagnosis, followed by intestinal atresia (12.2%). The overall
mortality rate was 57%. Mortality was more likely to occur among neonates with gastroschisis
compared to neonates with non-gastroschisis surgical conditions (76.7% vs 35.9%, OR=5.893,
p<0.001). Among neonates with gastroschisis, factors associated with mortality were the failure
of initiation of enteral feeding (100%, p=0.002) and sepsis (82.5%, p=0.001).
Among neonates with non-gastroschisis surgical conditions, factors associated with mortality
were prematurity (87.5%, OR:24, p=0.001), low birth weight (72.7% vs 21.4%, p=0.003), initiation
of enteral feeding at more than 48 hours (33.3% vs 25.8%, p=0.006), sepsis (64.7% vs 13.6%,
OR:11.61, p<0.001), and need of mechanical ventilation (63.6% vs 25%, OR:5.25, p=0.024,).
CONCLUSION: Neonatal surgical mortality is still a burden and has many predicting factors.
Improvement and advocacy are needed to reduce neonatal mortality.