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

AbstractBackground There is increasing evidence that pediatric surgical conditions are important public health problems and congenital anomalies contribute significantly to making neonatal surgery an important part of pediatric surgical care. Mortality associated with surgical conditions of neonates has significantly dropped in high-income countries but remains high in low-income countries. Objective This study aims to assess neonatal surgical patients' admission pattern and management outcomes at a tertiary hospital. Methods An institution-based cross-sectional study was conducted among 190 neonates who were admitted to St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia between September 2017, to September 2021, for surgical evaluation and/or intervention. Data was collected using a structured data collection tool from patients’ medical records. The collected responses were cleaned and entered into Epi info to achieve better checks and control during entry and exported to SPSS (v.26) for further statistical analysis. Results Hundred and ninety neonates were included in this study and the majority of the neonates were male with a median age of 2 days, and a mean weight of 2936 grams. Congenital anomalies accounted for 70% of the surgical conditions including gastrointestinal disorders (87, 46%), genitourinary (45, 23.6%), and craniospinal (14, 8.4%) conditions. Among the specific reasons for admission, Hirschsprung Disease (HSD), Anorectal malformations, and tracheoesophageal fistulas made up the majority of the cases accounting for 11.6, 9.0 and 7.4% of the admissions respectively. Of 103 neonates who underwent surgery, 92 (90%) underwent one surgery and the remaining 10% underwent more than one surgery. The most common procedure was colostomy which was done for 33 neonates, followed by myelomeningocele closure and pyloromyotomy which were done for 10 neonates each. The most frequently observed complications were sepsis, surgical site infections, and hematologic failure. The mean and median lengths of hospital stay were 10 and 6 days. The overall mortality rate was 26.8%, whereas mortality among those who underwent surgery was 20.6%. Sepsis (uncontrolled) was the commonest immediate cause of death (22, 43.1%) observed among study participants, followed by cardiorespiratory failure (15, 29.4%) and respiratory failure (8, 15.7%). Conclusion Neonatal surgical disorders, most of which are congenital, are widespread in the hospital, and disease conditions affecting the gastrointestinal tract were the most common indications for admission and Hirschsprung Disease (HSD) was the commonest specific disease. Neonatal surgical mortality is unacceptably high at 26.8%. Sepsis and surgical site infections accounted for a greater percentage of complications, with uncontrolled sepsis accounting for the majority of the deaths. Recommendation: Efforts to improve newborn surgical services, with an emphasis on the prevention and early treatment of sepsis, should be made. Local studies should also be encouraged to identify the specific risk factors and determinants of outcomes of neonatal surgical patients.