Neonatal surgical mortality and morbidity at the University Teaching Hospital of Kigali, a tertiary university hospital in Rwanda: analysis of predicting factors

Abstract

INTRODUCTION: Globally, high morbidity and mortality is associated with neonatal surgicalconditions. This study aimed to determine the factors influencing the mortality in neonates withsurgical conditions at Centre Hospitalier Universitaire de Kigali (CHUK).METHOD: This was a prospective study from October 2019 to March 2020. Analysis of patientswas divided based on a diagnosis of gastroschisis versus non-gastroschisis conditions. Odds ratioswere calculated at a confidence interval of 95%. Factors with p-value <0.05 on bivariate analysiswere considered.RESULTS: Eighty-two neonates were enrolled. 45.1% were admitted within the first 24 hours of life,61% were males, 26.9% were preterm, and 51.2% had birth weight less than 2500g. Gastroschisis(n=43, 52.4%) was the most common diagnosis, followed by intestinal atresia (12.2%). The overallmortality rate was 57%. Mortality was more likely to occur among neonates with gastroschisiscompared to neonates with non-gastroschisis surgical conditions (76.7% vs 35.9%, OR=5.893,p<0.001). Among neonates with gastroschisis, factors associated with mortality were the failureof initiation of enteral feeding (100%, p=0.002) and sepsis (82.5%, p=0.001).Among neonates with non-gastroschisis surgical conditions, factors associated with mortalitywere prematurity (87.5%, OR:24, p=0.001), low birth weight (72.7% vs 21.4%, p=0.003), initiationof enteral feeding at more than 48 hours (33.3% vs 25.8%, p=0.006), sepsis (64.7% vs 13.6%,OR:11.61, p<0.001), and need of mechanical ventilation (63.6% vs 25%, OR:5.25, p=0.024,).CONCLUSION: Neonatal surgical mortality is still a burden and has many predicting factors.Improvement and advocacy are needed to reduce neonatal mortality.