Factors affecting the outcome of neonates with anorectal malformation in a developing country

Abstract

Background: The survival and outcome of neonates with anorectal malformations (ARM) have much improved in the developed countries due to optimal perioperative and postoperative care but in developing countries, sepsis, low birth weight, delayed presentation, and lack of intensive care for neonates are still important in affecting the outcome. This study was carried out to evaluate factors of poor outcome (mortality) in neonates with ARM. Method: This is a prospective analytical study. A total of 44 consecutive neonates with Anorectal malformations (ARM) presenting to the Department of Pediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, were included. Variables studied included age at presentation, gender, birth weight, type of malformation, sepsis at presentation, type of surgery performed, postoperative complications, and their relationship to the outcome. The statistical analysis was performed using SPSS version 21. Results: A total of 44 neonates with ARM were included in the study. In the study population, 56.8 % (25) were males and 43.2% (19) were females. The mean age at presentation was 2.1 ± 0.5 days. The mean birth weight was 2.5 ± 0.6 kg. Overall mortality was 29.5% (13) with 13.63% (6) patients died pre-operatively. The most common cause of death in postoperative patients was sepsis (40%). There was a statistically significant relationship between low birth weight (P= <0.01) and sepsis at presentation (P=0.001) with mortality. No statistically significant association was found when the outcome was compared with age at presentation (P=0.21) and postoperative complications (P=0.16). Conclusion: In developing countries, the lack of resources, lack of trained midwives/LHVs, intensive care are contributing factors to sepsis and delayed presentation, and ultimately mortality. Good antenatal care, awareness of the midwives/Lady Health Visitors to refer such patients in time, and provision of adequate intensive care can improve the outcome of surgery in ARMs.

Survival and factors associated with mortality among infants with anorectal malformation: a population-based study from a middle-income country

“…A higher rate of mortality could be due to the inclusion of those who were treated with comfort care secondary to lethal congenital malformation as well as hypoplastic left heart syndrome in our cohort. Another reason was that notable death was related to infection in this study, which is still a common scenario in other lower-and-middle income countries (24).…”

The Outcome of Different Surgical Conditions in Neonates at A Tertiary Care Hospital: A Cross-Sectional Study

“…Stoma in the form of colostomy or ileostomy comprised the operation frequently performed in case of imperforate anus, Hirschsprung's disease, ileal atresia and meconium ileus, because the cases of anorectal malformations of high and intermediate variety and Hirschsprung's disease are traditionally managed in staged surgery. 11 All the neonates with NEC underwent peritoneal intubation as the primary surgical procedure while 4 of them required laparotomy and ileostomy as their condition was not improving with peritoneal intubation only. This type of management is supported by published literature.…”