The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
World Journal of Pediatric Surgery
Abstract
Bowel obstruction is a common surgical
emergency in newborns. One-fourth
of neonates with
obstruction suffer postoperative complications, with
high mortality, especially in low-income
countries.
Factors attributed to mortality include prematurity, late
presentation and associated multiple congenital anomalies.
The prevalence and the predictors of mortality in our
setting have not been well studied. We aimed to describe
the early postoperative outcomes and to determine
the predictors of mortality among neonates with bowel
obstruction.
Methods We conducted a prospective cohort study during
4 months, when we recruited postoperative neonates from
the pediatric surgery unit of Mulago Hospital. We collected
data on demographics, clinical presentations, maternal
characteristics, the surgical procedure performed,
postoperative outcomes, etc. After follow-up
for 2 weeks,
we analyzed the data using Cox proportional hazards
regression models of predictors of mortality.
Results A total of 76 neonates were recruited, with a
male-to-
female
ratio of 2.2:1. The age ranged from 1 to 26
days, a median of 3 [interquartile range (IQR): 2, 7]. About
67.1% had birth weights ranging between 2.5 kg and 3.5
kg, a mean of 2.8 [standard deviation(SD)=0.64]; 76.3%
were termed; with anorectal malformation (ARM), 31.6%
as the leading cause, followed by jejunoileal atresia (JIA),
25%. Nearly 55.3% of neonates developed complications;
53.9% with post-operative
fever, 15.8% had wound sepsis.
The mortality rate was 44.7% (34/76) and was highest
among cases of JIA, 41.2%. The predictors of mortality
included prematurity, fever at admission, breastfeeding
status, and mother’s parity as well as the cadre of
healthcare providers (p<0.005).
Conclusions ARM is the predominant cause of bowel
obstruction among neonates, followed by JIA. The
morbidity and mortality due to bowel obstruction among
neonates are unacceptably high. The major predictors of
mortality were prematurity, fever at admission, and the
cadre of the healthcare providers.
Description
Keywords
Etiological spectrum, Bowel obstruction, Postoperative outcome, Neonates, Tertiary hospital
Citation
Otim P, Elobu EA, Mbiine R, et al. The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda. World Jnl Ped Surgery 2022;5:e000377. doi:10.1136/wjps-2021-000377