A pilot study on neonatal surgical mortality: A multivariable analysis of predictors of mortality in a resource-limited setting

Puri, Archana; Lal, Brahmanand; Nangia, Sushma

doi:10.4103/jiaps.jiaps_30_18

Cited by 21 publications

(29 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[22][23][24] Puri et al observed that LBW and premature babies were associated with a higher probability of NSM. [21] The same was observed in this study.…”

Section: Discussionsupporting

confidence: 88%

Congenital intrinsic duodenal obstruction: Clinical study and predictors of neonatal surgical mortality

2022

View full text Add to dashboard Cite

Background: This study was aimed to analyze the clinical profile and the predictors of neonatal surgical mortality of congenital intrinsic duodenal obstruction (CIDO). Methods: This is a case series of 67 patients with CIDO (duodenal atresia and stenosis) admitted at our teaching institute, from October 2018 to June 2020. The demographic data, clinical presentation, diagnostic methods, location & type of duodenal atresia, the operative procedure performed, and neonatal surgical mortality (NSM) predictors such as birth weight, age on presentation, associated anomalies, duration of surgery, extubation after surgery, sepsis, and vasopressors support were analyzed. Results: Of 67 patients, 40(60%) were premature; mean weight and age at presentation were 2.06±0.6 (1-8 kg) and 6.7(1-240days), respectively. The majority of patients (59, 88%) presented with vomiting, and the most common finding on the x-ray abdomen was a double bubble sign (54, 81%). Twenty-four (36%) were associated with congenital heart disease and 19(28%) had Down’s syndrome. Type 3 duodenal atresia was the commonest finding in 43(64%) followed by type 1 in 22 (33%), and type 2 in 2(3%). In 49 (73%) Kimura’s duodenoduodenostomy, excision of web & duodenoplasty in 13 (19%), and side to side duodenoduodenostomy in 4 (6%), were performed. The mean hospital stay of survivors was 9 days. Overall survival was 63%. Conclusion: Type 3 duodenal atresia is the commonest variety observed. The prematurity, low birth weight, associated major congenital anomalies, surgery >90 minutes, delayed extubation after surgery, sepsis, and need for vasopressors support are significant predictors of NSM.

show abstract

“…[22][23][24] Puri et al observed that LBW and premature babies were associated with a higher probability of NSM. [21] The same was observed in this study.…”

Section: Discussionsupporting

confidence: 88%

Congenital intrinsic duodenal obstruction: Clinical study and predictors of neonatal surgical mortality

2022

View full text Add to dashboard Cite

show abstract

“…For achieving the best outcomes, optimization of perioperative stress factors is required apart from a high degree of surgical precision. Factors significantly associated with poor survival outcomes after newborn surgery include preoperative - low birth weight, lesser gestational age, positive blood cultures, and associated congenital anomalies; intraoperative - prolonged duration of surgery, blood loss of >10% blood volume, and intraoperative hypothermia; and postoperative - a requirement of mechanical ventilation for a prolonged duration, need for high-dose of vasopressors, postoperative sepsis, major complications in the postoperative period, and prolonged fasting [ 1 ]. A number of these risk factors are linked to unnecessary intra-hospital or inter-hospital transport of newborns [ 2 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The care of a surgical newborn is extremely challenging and requires the continuous involvement of skilled neonatologists for favorable outcomes. Despite a better understanding of postnatal and transitional neonatal care, the mortality rates among surgical newborns can be as high as >60% in developing countries [ 1 ]. Numerous preoperative, intraoperative, and postoperative factors have been linked with poor survival outcomes in these newborns [ 1 , 2 ] One major risk factor is the transport of critically ill and/or preterm surgical newborns to and from the operation room (OR).…”

Section: Introductionmentioning

confidence: 99%

“…Despite a better understanding of postnatal and transitional neonatal care, the mortality rates among surgical newborns can be as high as >60% in developing countries [ 1 ]. Numerous preoperative, intraoperative, and postoperative factors have been linked with poor survival outcomes in these newborns [ 1 , 2 ] One major risk factor is the transport of critically ill and/or preterm surgical newborns to and from the operation room (OR). It has been demonstrated that various unfavorable incidents including hypothermia, displacement of the endotracheal tube, dislodgements of the intravenous lines, etc.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Operating Within the Neonatal Intensive Care Unit: A Retrospective Analysis From a Tertiary Care Center

Anand

Sandlas

Nabar

et al. 2021

Cureus

View full text Add to dashboard Cite

BackgroundDespite ongoing advances in the field of neonatology, the survival outcomes among critically ill preterm surgical neonates remain unfavorable. Intrahospital transport is one of the major risk factors associated with early mortality (within 30 days) in these newborns. To overcome this, the approach of performing bedside surgeries is being followed. We aim to assess the safety and feasibility of performing bedside neonatal surgeries by analyzing our archives. MethodsThe study focused on retrospective evaluation of all the newborns who have undergone surgical procedures in the neonatal intensive care unit (NICU) at our center from August 2015 through February 2021. Newborns were operated within the NICU if they had very low birth weight or other risk factors making their transport to the operation room risky. The outcomes of surgeries were assessed in terms of postoperative complications, one-month survival, and overall survival. ResultsThirteen children (M:F=9:4) underwent twenty-two surgical procedures. The median (range) gestational age and birth weight of our cohort were 30 (26-36) weeks and 1200 (500-2860) grams, respectively. One-month and overall survival rates in our cohort were 84% (11/13) and 77% (10/13), respectively. No major postoperative complications were observed. The requirement of multiple inotropes and/or high-frequency oscillatory ventilation (HFOV) was the only factor having a significant association with unfavorable survival outcomes. ConclusionsBedside surgery is a safe and feasible alternative to surgeries within the operation room for at-risk newborns. In the present study, the requirement of multiple inotropes and/or HFOV was the only factor significantly associated with early mortality.

show abstract

“…Besides that, neonatal surgery requires expert special training to minimize the duration of surgery and well-equipped SICU with trained manpower. 1,19 In our experiences, despite this relatively high mortality rate, it has certainly decreased in recent years as compared to the rate from previous years. This downward trend can likely be attributed to an improvement in surgical techniques, neonatal anesthesia, modern ventilatory support, and advanced intensive care management.…”

Section: Discussionmentioning

confidence: 57%

Five years experiences in diagnosis and management of jejuno-ileal atresia in Kanti children’s hospital

Basnet

Thapa

Dhoubadel

et al. 2020

J. Soc. Surg. Nepal

View full text Add to dashboard Cite

Introduction: Jejuno-ileal atresia is a major cause of neonatal intestinal obstruction. The aim of this study is to evaluate the incidence, clinical presentation, management, and outcome of jejunoileal atresia at our institute over a period of five years. Methods: The medical records of the patients with the diagnosis of jejunoileal atresia during a period of five years (April 2014 to April 2019) were obtained from the hospital record section and surgical intensive care unit, and were reviewed and analyzed. Results: There were 61 cases of jejunoileal atresia among 144 cases of intestinal atresia. Twenty-nine (47.5%) of them were male. Laparotomy with resection of atretic part with anti-mesenteric tapering enteroplasty and end to end anastomosis was done in 15, and resection without tapering enteroplasty with end to end anastomosis was done in 39 patients. Thirty-eight patients (62.3%) were discharged while Twenty-three (37.7%) cases were lost to mortality. Conclusions: Although the mortality and morbidity rate are high in jejunoileal atresia, early diagnosis, improvement in surgical technique, modern ventilatory support and advanced in intensive care unit has led to the significant increase in the survival rate.

show abstract

A pilot study on neonatal surgical mortality: A multivariable analysis of predictors of mortality in a resource-limited setting

Cited by 21 publications

References 22 publications

Congenital intrinsic duodenal obstruction: Clinical study and predictors of neonatal surgical mortality

Congenital intrinsic duodenal obstruction: Clinical study and predictors of neonatal surgical mortality

Operating Within the Neonatal Intensive Care Unit: A Retrospective Analysis From a Tertiary Care Center

Five years experiences in diagnosis and management of jejuno-ileal atresia in Kanti children’s hospital

Contact Info

Product

Resources

About