Retrospective study of neonatal intestinal obstruction in Calabar: Aetiology and outcome

Abstract

Neonatal intestinal obstruction is the most common surgical emergency in the newborn period. Prompt diagnosis and urgent management improve the chances of a favorable outcome. Aetiology and outcome may vary in different parts of the same country. Objective: To evaluate the aetiology and factors associated with mortality in neonates presenting with intestinal obstruction in University of Calabar Teaching Hospital, Calabar, Nigeria. Method: This was a retrospective study of clinical records of neonates presenting with features of intestinal obstruction over an eight year period. The biodata, diagnosis, management and outcome for the neonates were documented. Result: Forty neonates; 26(65%) males and 14(35.5%) females were studied. Imperforate anus was seen in 40% of subjects while Hirschsprung's disease and intestinal atresia each were seen in 10%. Aetiology could not be determined in about a fifth of the cases. Age less than one week at presentation was significantly associated with a poor outcome. No case had surgical intervention within twenty-four hours of presentation. The overall mortality was 30%, most of these 9 (75%) was due to anorectal malformations. Conclusion: The management and outcome of neonatal intestinal obstruction in our setting is poor. There is urgent need to upgrade our neonatal intensive care services to improve outcome in affected neonates. More Paediatric surgeons are required to reduce the gross inadequacy of expert as this would improve on the surgical intervention time as reported in this study.

Assessment of Predictors of Mortality in Neonatal Intestinal Obstruction

“…[11] The complications noted in our patients were similar to those noted by other authors. [7,10,13,14,16] Continued post-operative mechanical ventilation after surgery was a significant risk factor for mortality in our series. The reason for bad prognosis in such patients who needed continued post-operative mechanical ventilation was the fact that this reflected their bad general condition prior to surgery.…”

“…Similar observations were made by other authors also. [7,8,10,13] ARM was seen in 30 (25%) neonates out of which 24 survived. Four out of 6 ARM patients who died presented to us late (after 4 days of life) with colonic perforation and peritonitis.…”

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

“…1 2 The common causes include intestinal atresia, Hirschsprung's disease (HD), and anorectal malformation (ARM). [3][4][5] The cardinal features are bile-stained vomiting, failure to pass meconium, and abdominal distension. 3 6 7 Though none of these features are pathognomic, all are consistent with an obstructive phenomenon.…”

“…4 10 However, early diagnosis and treatment lead to better outcome. 5 6 Similarly, surgery in neonates is still a challenging issue, especially in low-income countries. 7 11 12 Neonates usually require surgical management by trained pediatric surgeons in centers equipped with specialized anesthetic and neonatal intensive care.…”

“… 7 11 12 Neonates usually require surgical management by trained pediatric surgeons in centers equipped with specialized anesthetic and neonatal intensive care. 5 13 This is usually not the case in many settings, and hence nearly 25% of the neonates with obstruction suffer complications, such as sepsis, surgical site infection, and an anastomotic leak in their early postoperative period. 10 14…”