Disparity in access and outcomes for emergency neonatal surgery: intestinal atresia in Kampala, Uganda

Cairo, Sarah B.; Kakembo, Nasser; Kisa, Phyllis; Muzira, Arlene; Cheung, Maija; Healy, James M.; Ozgediz, Doruk; Sekabira, John

doi:10.1007/s00383-017-4120-5

Cited by 17 publications

(14 citation statements)

References 31 publications

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“…These findings, however, were not in agreement with the report by Cairo et al, wherein many neonates with intestinal atresia presented after day 7. 18 HD, on the other hand, was a major cause of obstruction in other reports, but in our study the incidence was low. 4 11 A study conducted by Saha et al showed a 35.3% incidence of HD, higher than that of atresia, whereas in other related studies the incidence was almost equal, with HD leading over atresia.…”

Section: Etiological Spectrumcontrasting

confidence: 71%

“…16 A report by Cairo et al indicated a mortality rate of 43% among neonates with intestinal atresia. 18 These figures are quite high compared to the findings in Europe, where a mortality is less than 15% among neonates with obstruction. 3 9 With such glaring disparities in mortality, there is a huge need to understand the high rate and more specially to identify the predictors, which are not well elucidated in our setting.…”

Section: Open Accessmentioning

confidence: 76%

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The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

Otim

Elobu

Mbiine

et al. 2022

World Jnl Ped Surgery

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BackgroundBowel 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.MethodsWe 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.ResultsA 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).ConclusionsARM 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.

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Section: Etiological Spectrumcontrasting

confidence: 71%

Section: Open Accessmentioning

confidence: 76%

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

Otim

Elobu

Mbiine

et al. 2022

World Jnl Ped Surgery

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“…A newborn is a baby born within 28 days from umbilical cord ligation. Neonatal intestinal obstruction refers to the obstruction of the normal delivery of the contents of the intestinal cavity of the newborn to cause partial or complete failure to pass, resulting in systemic physiological dysfunction [10]. e incidence rate is higher than 1%, which is the main cause of neonatal acute abdomen and one of the important causes of perinatal infant death [11].…”

Section: Discussionmentioning

confidence: 99%

Artificial Intelligence Algorithm-Based Computed Tomography Images in the Evaluation of the Curative Effect of Enteral Nutrition after Neonatal High Intestinal Obstruction Operation

Dong

Wang

Zhang

et al. 2021

Journal of Healthcare Engineering

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In this study, CT image technology based on level set intelligent segmentation algorithm was used to evaluate the postoperative enteral nutrition of neonatal high intestinal obstruction and analyze the clinical treatment effect of high intestinal obstruction, so as to provide a reasonable research basis for the clinical application of neonatal high intestinal obstruction. 60 children with high intestinal obstruction treated in the hospital were selected as the research objects. Based on the postoperative enteral nutrition treatment, they were divided into control group (noncatheterization group)-parenteral nutrition support. In the observation group, gastric tube was placed through nose for nutritional support. Then, CT images based on level set segmentation algorithm were used to compare the intestinal recovery of the two groups, and the biochemical indexes and hospitalization were compared. The level set algorithm can accurately segment the lesions in CT images. The segmentation time of the level set algorithm was shorter than that of the traditional algorithm (24.34 ± 2.01 s vs. 75.21 ± 5.91 s), and the segmentation accuracy was higher than that of the traditional algorithm (84.71 ± 3.91% vs. 70.04 ± 3.71%, P < 0.05). The weight of children in the observation group (100 ± 7 g) was higher than that in the control group (54 ± 5 g), and the ICU monitoring time (12.01 ± 2.65 days) and the hospital stay (17.82 ± 3.11 days) were shorter than those in the control group (13.42 ± 2.95 days, 19.13 ± 3.22 days, all P < 0.05). The level set segmentation algorithm can accurately segment the CT image, so that the disease location and its contour can be displayed more clearly. Moreover, the nasal placement of jejunal nutrition tube can effectively improve the intestinal function of children, maintain the steady-state environment of intestinal bacterial growth, and significantly improve the clinical treatment effect, which is worthy of clinical application and promotion.

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“…The surgical management for ileal atresia reported by Hiller et al is in favour of primary resection and anastomosis than secondary anastomosis (14). This neonate was managed by constructing a double-barrel ileostomy owing to the fact there was gross peritoneal contamination by meconium and bowel oedema mitigating the risk of the anastomotic leak (15). Consequently, the neonate deteriorated at home following poor, inadequate breast-feeding by the mother and eventually died in the hospital upon readmission from severe acute malnutrition and hypothermia six weeks later.…”

Section: Discussionmentioning

confidence: 99%

Neonatal small bowel perforation in ileal atresia in a low resource setting: A case report

Okidi¹,

Viola²,

Aber³

et al. 2020

Preprint

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Jejunoileal atresia is a common cause of neonatal intestinal obstruction with high mortality and morbidity in a low resource setting where surgical care is lacking. Herein, a 4-day-old presented with features of acute abdomen and septicaemia, managed with ileostomy diversion and recovered uneventfully. Back ground Neonatal surgical care and neonatal intensive care is lacking in Uganda while jejunoileal atresia and stenosis are still the most common causes of neonatal intestinal obstruction with high mortality and morbidity in a low resource setting. Herein, we presented a 4-day-old neonate who presented to the emergency department as a referral from distant peripheral hospital with features of acute abdomen and septicaemia. He was resuscitated and an ileostomy diversion created. He recovered uneventfully from the hospital and discharged. However, he passed on upon readmission six weeks later from severe acute malnutrition. Conclusion A high index of suspicious on concomitant intestinal perforation in a neonate presenting with intestinal obstruction and delayed access to surgical care while approaches such as intestinal diversion should be sought carefully to mitigate serious consequences of anastomotic leak from primary bowel repair.

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Disparity in access and outcomes for emergency neonatal surgery: intestinal atresia in Kampala, Uganda

Abstract: Level IV, Case series with no comparison group.

Cited by 17 publications

References 31 publications

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

Artificial Intelligence Algorithm-Based Computed Tomography Images in the Evaluation of the Curative Effect of Enteral Nutrition after Neonatal High Intestinal Obstruction Operation

Neonatal small bowel perforation in ileal atresia in a low resource setting: A case report

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