Neonatal surgery in a developing country: Outcome of co‐ordinated interdisciplinary collaboration

Ekenze, Sebastian O.; Modekwe, Victor O; Ajuzieogu, Obinna V.; Asinobi, Isaac Nwabueze; Sanusi, Jubril

doi:10.1111/jpc.13610

Cited by 10 publications

(9 citation statements)

References 21 publications

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“…According to UNICEF child mortality report (2019), neonatal deaths accounted for 47 per cent of all under-five deaths and it has been predicted that 26 million new-borns would die between 2019 and 2030, and 80 per cent of these deaths would occur in Southern Asia and sub-Saharan Africa [8]. Studies showed that the outcome of neonatal surgical conditions in these regions is also dismal [3,7,10,[14][15][16]. This clearly denotes that some babies born in the LMICs are very unfortunate, and had they been born in any developed world, a large portion of them could have led a normal life.…”

Section: Discussionmentioning

confidence: 99%

Mortality from Surgical Conditions in Children: An Insight from a Tertiary-Level Government Hospital in Bangladesh

Chowdhury

Kabir²,

Farooq

et al. 2020

AJPR

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Aims: While the developed world has significantly reduced mortality from surgical conditions in children, there is lack of adequate data on the outcome of children’s surgical conditions in the developing world. This study aims at assessing the spectrum of mortalities from children’s surgical conditions in a low-middle income country (LMIC). Methods: Mortality data were collected for a period of 12 years (2008 to 2019) among 0 to12-year old children to analyse the diseases which had higher mortality trends, age -group specific mortality trends and categorize those according to body system. Results: Among a total of 30,301 admitted children, 1228 (4.05%) patients died. Among them 53.01% were neonates, 20.28% were infants and 26.71% were children. Male to female ratio was 1.95:1. Mortality from neonatal surgical conditions was 24.21%. Infant mortality rate was 5.65% and child mortality rate was 1.41%. Neonatal surgical admission and mortality had a higher yearly trend. Anorectal malformation (ARM) was the most common cause of death (12.05%), followed by intestinal obstruction (11.40%) and gastroschisis (8.63%). Tracheo-oesophageal fistula/ oesophageal atresia (TOF/OA) had the highest mortality rate (83.33%), followed by gastroschisis (80.92%) and intestinal atresia (42.535) among the respective admissions. Other important causes of mortality were jejuno-ileal atresia (5.37%), trauma (5.05%), Hirschsprung disease (4.64%), intestinal perforation (4.48%), omphalocele (4.15%), burn (4.07%) and posterior urethral valves (PUV), 3.58%. Conclusion: Overall mortality rate was much higher than developed countries and lower than some African countries. Neonatal mortality rate was very high and among them TOF/OA and gastroschisis had extremely high mortality rates.

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Section: Discussionmentioning

confidence: 99%

Mortality from Surgical Conditions in Children: An Insight from a Tertiary-Level Government Hospital in Bangladesh

Chowdhury

Kabir²,

Farooq

et al. 2020

AJPR

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“…Our results confirm these findings, and we strongly support the implementation of an interdisciplinary approach with pediatric surgery consultation as a part of the initial examination in cases of unclear anogenital findings to improve outcome. 36…”

Section: Time Of Diagnosis and Clinical Findingsmentioning

confidence: 99%

Risk factors for anorectal and associated malformations in German children: A 10-year analysis

Kapapa

Becker

Serra

2021

Pediatrics & Neonatology

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Background: Incidences of anorectal malformations (ARM) occur in 1 of 2000e5000 live births and up to 64% have associated malformations (ARMa). The aim of the study was to evaluate possible prenatal risk factors for ARM in a tertiary hospital. Methods: A caseecontrol design was used to compare risk factors in ARM (n Z 44) to a control group (CG; n Z 26). We used modified prenatal questionnaires, analyzed mothers' prenatal records and participants completed a structured interview. Endpoints were medical history, drug consumption, occupational risk factors, and time point of diagnosis, associated malformations and sensitivity of radiological imaging. Results: Our results showed that ARM couples had a significantly higher age difference (p Z 0.028) compared to CG. ARM mothers had more abnormalities during pregnancy (p Z 0.002), more positive vaginal smears of group B streptococci (p Z 0.024), urogenital infections (p Z 0.005), gestosis (p Z 0.03), emesis (p Z 0.025) and higher numbers of chronic diseases (p Z 0.018). ARM mothers took less medication during pregnancy (p Z 0.013) than CG mothers including folic acid (p Z 0.041); their intake of iodine tablets was significantly higher (p Z 0.035) and they continued smoking for longer (p Z 0.036) than CG mothers, and they had more stillbirths (p Z 0.035). In using illegal drug and alcohol use, the groups did not show significant differences. ARMa was present in 68.1% (n Z 30), of which 45.5% were of urogenital origin (n Z 20). ARM diagnosis was made on the first day of life in 72.7% (n Z 32), while diagnosis was delayed in 12 patients (27.3%). Conclusion: A combination of different risk factors seem to be associated with the development of ARM, which takes place at an early stage (<7th week) of pregnancy. Therefore, risk factors influencing fetal development must be critically considered. We advocate an

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“…Ekenze et al . undertook a QI project focussed on co-ordinating interdisciplinary collaboration to improve neonatal surgery outcomes in Nigeria 81 . The intervention involved short-term neonatal surgery training for the paediatric surgeons, nurses and anaesthetists in Europe and the US followed by MDT training locally upon their return.…”

Section: Introductionmentioning

confidence: 99%

Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings

et al. 2019

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Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary paediatric surgery centres across SSA. Methods: A hybrid type-2 effectiveness-implementation, pre-post study design will be utilised. Using current literature an evidence-based, low-technology interventional bundle has been developed. A systematic review, qualitative study and Delphi process will provide further evidence to optimise the interventional bundle and implementation strategy. The interventional bundle has core components, which will remain consistent across all sites, and adaptable components, which will be determined through in-country co-development meetings. Pre- and post-intervention data will be collected on clinical, service delivery and implementation outcomes for 2-years at each site. The primary clinical outcome will be all-cause, in-hospital mortality. Secondary outcomes include the occurrence of a major complication, length of hospital stay and time to full enteral feeds. Service delivery outcomes include time to hospital and primary intervention, and adherence to the pre-hospital and in-hospital protocols. Implementation outcomes are acceptability, adoption, appropriateness, feasibility, fidelity, coverage, cost and sustainability. Pre- and post-intervention clinical outcomes will be compared using Chi-squared analysis, unpaired t-test and/or Mann-Whitney U test. Time-series analysis will be undertaken using Statistical Process Control to identify significant trends and shifts in outcome overtime. Multivariate logistic regression analysis will be used to identify clinical and implementation factors affecting outcome with adjustment for confounders. Outcome: This will be the first multi-centre interventional study to our knowledge aimed at reducing mortality from gastroschisis in low-resource settings. If successful, detailed evaluation of both the clinical and implementation components of the study will allow sustainability in the study sites and further scale-up. Registration: ClinicalTrials.gov Identifier NCT03724214.

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Neonatal surgery in a developing country: Outcome of co‐ordinated interdisciplinary collaboration

Abstract: Despite the persisting challenges, co-ordinated team management may result in the modest improvement of outcomes of neonatal surgery in our setting. Addressing these challenges may further improve outcomes.

Cited by 10 publications

References 21 publications

Mortality from Surgical Conditions in Children: An Insight from a Tertiary-Level Government Hospital in Bangladesh

Mortality from Surgical Conditions in Children: An Insight from a Tertiary-Level Government Hospital in Bangladesh

Risk factors for anorectal and associated malformations in German children: A 10-year analysis

Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings

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