Neonatal surgery : A ten year audit from a university hospital

Abstract

Neonatal surgery is the flagship and most challenging component of pediatric surgery, which is the youngest subspeciality of surgery. Neonatal surgery carried a survival rate of only 30% three decades ago. In the last decade there has been a significant change in the scenario. Earlier recognition and referral of these anomalies, availability of neonatal intensive care, better preoperative planning, decision, and techniques have lead to the change in the management. This is an audit into the outcome of neonatal surgery from one of the largest units in India over a ten year period. This audit reveals an across the board survival of 65-70% newborns after surgery on nearly two thousand case over a ten year period. It has an important message that while pediatric surgery units expand, risk stratification of surgical newborns and their treatment in suitable units is mandatory to maintain and improve these figures to match international standards over the next decade.

Surgical Admissions in a Newborn Unit in a Low Resource Setting, Challenges in Management and Outcomes

“…Majority of the babies were born outside hospital. This is similar to findings by other authors both in Nigeria and other developing countries [4,8]. Being born outside the hospital implies poor antenatal care and lack of antenatal diagnoses.…”

Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn

“…To place results in context, nowadays, global neonatal surgical mortality is variable, especially depending on the level of development of the country. Two large studies reported 6.7 14 and 7.5% 13 in South Korea and Japan, respectively, which compares favorably to 35 and 45% in studies from India 15 and Nigeria 16,17 , respectively. In our cohort, despite the large number of patients with disabling illness (45.5% classified as ASA 3 or higher), there were no intraoperative deaths.…”

“…Firstly, very few studies can be found in literature addressing specifically the surgical infant and neonatal populations [14][15][16][17]30,31 and none focuses on the impact of clinical risk factors on outcomes or includes such a broad range of surgical pathologies. The present study aims to fulfill this gap.…”

Clinico-Aetiological Evaluation of Respiratory Distress in Newborn and Its Immediate Outcome Admitted in a Tertiary Care Teaching Hospital, South India

“…Among these, 2 babies recovered and 1 baby expired; 1 baby with CDH was not operated as baby had severe distress and expired in spite of giving ventilatory support soon after admission (50% mortality -2 out of 4 cases). In a large study done by Upadhyaya et al, [33] out of 92 cases of CDH mortality was 44.7%. In another study conducted by Jain et al, [34] the overall survival rate was about 40% and lower in those with distress at birth.…”