OUTCOMES OF NEONATAL SURGERIES WITHOUT NICU IN LMIC

SKH SHAH; S FAYAZ; MB ASAD; FR SHAHID; SH LONE; A ZAKA

doi:10.54112/bcsrj.v2024i1.972

Authors

SKH SHAH Department of pediatric surgery pims Islamabad, Pakistan
S FAYAZ Department of pediatric surgery pims Islamabad, Pakistan
MB ASAD Department of adult ICU Shahida khaliq health center Islamabad, Pakistan
FR SHAHID Department of NICU/ PiCU Shahida khaliq health center Islamabad, Pakistan
SH LONE Department of pediatric surgery pims Islamabad, Pakistan
A ZAKA Department of gyne/ obs CMH rawlakot AJ&K, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.972

Keywords:

Pediatric surgery, neonatal surgery, challenges, LMIC, NICU

Abstract

Dealing with neonatal surgery, which nearly invariably entails emergency neonatal surgical scenarios, is the most challenging and complex problem in pediatrics and pediatric surgery. Congenital abnormalities are the most common reason for emergency neonatal surgery. Pakistan and other low and middle-income countries (LMICs) account for over ninety percent of these abnormalities. Objective: Our goal is to examine the factors contributing to the high mortality rate in neonatal surgery among those individuals who didn't have access to the NICU. This will inform our recommendations for the worldwide community and the need for NICU care post-operatively. Method: This prospective research was carried out in PIMS hospital from December 2022 to December 2023. Our center has a 15-bed NICU facility, which is almost negligible compared to the patient load of our center. Two hundred patients who underwent surgery during the study were enrolled in our study. Demographic and clinical data were gathered using a questionnaire, and SPSS 25 was used for analysis. Results: Throughout the study period, 33 of 200 neonates died, resulting in a 16.5% mortality rate. Over 53% of these cases were preterm. The research had a minimum gestation age of 29 weeks and a mean gestational age of 35.54 ± 3.56 weeks. The mean newborn's weight had been 2.41 ± 0.52 kg (range: 1.22–3.5 kg). There were more male babies (67.5%) than females. Anorectal malformation was found in four infants who died following surgery. Gastroschisis was discovered in five infants who died after surgery. Sepsis was the most common cause of death following neonatal surgery, amounting to 84.84% of total deaths. Cardiogenic shock was the reason for expiry in 9.09% of the cases, and 6.06% of the cases had respiratory failure as the cause of death. Gastroschisis and esophageal atresia were associated with the most significant mortality. Conclusions: In underdeveloped nations like Pakistan, surgical infants account for a sizable fraction of the total neonatal death rate, most of which may be avoided with proper perioperative and NICU care. Nevertheless, the national health strategy does not give neonatal surgery the priority it deserves. NICUs should be established countrywide to enhance patient care and decrease the overall mortality rate of pediatric surgery.

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References

Withers A, Cronin K, Mabaso M, Brisighelli G, Gabler T, Harrison D, et al. Neonatal surgical outcomes: a prospective observational study at a Tertiary Academic Hospital in Johannesburg, South Africa. Pediatric Surgery International. 2021;37:1061-8.

Ng-Kamstra JS, Nepogodiev D, Lawani I, Bhangu A, Workneh RS. Perioperative mortality as a meaningful indicator: challenges and solutions for measurement, interpretation, and health system improvement. Anaesthesia Critical Care & Pain Medicine. 2020;39(5):673-81.

Collaboration GPR. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. 2021.

Sherwani M, Abib S, Samad L, editors. Barriers and challenges to achieving equity in global children's surgery: a call to action. Seminars in Pediatric Surgery; 2023: Elsevier.

Aghai ZH, Goudar SS, Patel A, Saleem S, Dhaded SM, Kavi A, et al. Gender variations in neonatal and early infant mortality in India and Pakistan: a secondary analysis from the Global Network Maternal Newborn Health Registry. Reproductive health. 2020;17:1-11.

Dhaded SM, Saleem S, Goudar SS, Tikmani SS, Hwang K, Guruprasad G, et al. The causes of preterm neonatal deaths in India and Pakistan (PURPOSe): a prospective cohort study. The Lancet Global Health. 2022;10(11):e1575-e81.

Tharwani ZH, Bilal W, Khan HA, Kumar P, Butt MS, Hamdana AH, et al. Infant & child mortality in Pakistan and its determinants: A review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2023;60:00469580231167024.

Dowou RK, Amu H, Saah FI, Adeagbo O, Bain LE. Increased investment in Universal Health Coverage in Sub–Saharan Africa is crucial to attain the Sustainable Development Goal 3 targets on maternal and child health. Archives of Public Health. 2023;81(1):34.

Aziz A, Saleem S, Nolen TL, Pradhan NA, McClure EM, Jessani S, et al. Why are the Pakistani maternal, fetal and newborn outcomes so poor compared to other low and middle-income countries? Reproductive Health. 2020;17:1-12.

Puri S, Sen IM, Bhardwaj N, Yaddanapudi S, Mathew PJ, Bandyopadhyay A, et al. Postoperative outcome of neonatal emergency surgeries in a tertiary care institute—A prospective observational study. Pediatric Anesthesia. 2023;33(12):1075-82.

Hasan MS, Islam N, Mitul AR. Neonatal surgical morbidity and mortality at a single tertiary center in a low-and middle-income country: a retrospective study of clinical outcomes. Frontiers in Surgery. 2022;9:817528.

El Manouni El Hassani S, Niemarkt HJ, Derikx JP, Berkhout DJ, Ballón AE, de Graaf M, et al. Predictive factors for surgical treatment in preterm neonates with necrotizing enterocolitis: a multicenter case-control study. European journal of pediatrics. 2021;180:617-25.

Ammar S, Sellami S, Sellami I, Hamad AB, Hbaieb M, Jarraya A, et al. Risk factors of early mortality after neonatal surgery in Tunisia. Journal of Pediatric Surgery. 2020;55(10):2233-7.

Watters D, Wilson L. The comparability and utility of perioperative mortality rates in global health. Current Anesthesiology Reports. 2021;11:48-58.

Panchbudhe SA, Shivkar RR, Banerjee A, Deshmukh P, Maji BK, Kadam CY. Improving newborn screening in India: Disease gaps and quality control. Clinica Chimica Acta. 2024:117881.

Hossain MZ, Ali MN, Shahid SMA, Paul SR, Al Mamun A. Burden of Neonatal Surgical Conditions and Their Outcomes in a Resource-Limited Tertiary Hospital in Bangladesh. Sch J App Med Sci. 2024;6:776-85.

Rouf M, Hasan T, Alam S, Hanif'Tablu A, Hasina K, Moniruddin A. Clinical Pattern and Outcome of Neonates with Surgical Problems in Dhaka Medical College Hospital. KYAMC Journal. 2022;13(2):86-93.

Jerry AL, Amboiram P, Balakrishnan U, Chandrasekaran A, Agarwal P, Devi U. Clinical profile, outcomes and predictors of mortality in neonates operated for gastrointestinal anomalies in a tertiary neonatal care unit-An observational study. Journal of Indian Association of Pediatric Surgeons. 2022;27(3):287-92.

Mahtam I, Sirajuddin Soomro S. The Outcome of Different Surgical Conditions in Neonates at A Tertiary Care Hospital: A Cross-Sectional Study. Methodology. 2021.

Sohrab S, Shabbir T, Kousar R, Hussain S, Siddique Q, Khoso SA. Major Congenital Malformations of Gastrointestinal Tract Among Neonates Presenting to Tertiary Care. Pakistan Journal of Medical & Health Sciences. 2022;16(07):755-.

Zhao A. Increasing Access to Essential Surgery in Resource Restricted Settings: An Economic Analysis: The University of Western Ontario (Canada); 2021.

Memon A, Kazi NH, Javed S, Begum N. Outcomes and Frequency of Neonatal Diseases Observed in the Neonatal ICU of the Paediatric Department of a Tertiary Care Hospital. Pakistan Journal of Medical & Health Sciences. 2023;17(03):483-.