Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study

Authors

  • Hyginus Okechukwu Ekwunife Nnamdi Azikiwe University Teaching Hospital, Nnewi Anambra State Nigeria
  • Emmanuel Ameh Department of surgery, National Hospital Abuja
  • Lukman Abdur-Rahman Department of surgery, University of Ilorin/University of Ilorin Teaching Hospital
  • Adesoji Ademuyiwa Department of surgery, College of Medicine, University of Lagos
  • Emem Akpanudo Department of surgery, University of Uyo Teaching Hospital Uyo
  • Felix Alakaloko Department of surgery, Lagos University Teaching Hospital Lagos

DOI:

https://doi.org/10.47338/jns.v11.1029

Keywords:

Neonatal surgery, Complications, Mortality, Predictors, Quality improvement

Abstract

Background:  Despite a decreasing global neonatal mortality, the rate in sub-Saharan Africa is still high. The contribution and the burden of surgical illness to this high mortality rate have not been fully ascertained. This study is performed to determine the overall and disease-specific mortality and morbidity rates following neonatal surgeries; and the pre, intra, and post-operative factors affecting these outcomes. 

Methods: This was a prospective observational cohort study; a country-wide, multi-center observational study of neonatal surgeries in 17 tertiary hospitals in Nigeria. The participants were 304 neonates that had surgery within 28 days of life. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measure was 30-day postoperative complication rates.

Results: There were 200 (65.8%) boys and 104 (34.2%) girls, aged 1-28 days (mean of 12.1 ± 10.1 days) and 99(31.6%) were preterm. Sepsis was the most frequent major postoperative complication occurring in 97(32%) neonates. Others were surgical site infection (88, 29.2%) and malnutrition (76, 25.2%). Mortality occurred in 81 (26.6%) neonates. Case-specific mortalities were: gastroschisis (14, 58.3%), esophageal atresia (13, 56.5%) and intestinal atresia (25, 37.2%). Complications significantly correlated with 30-day mortality (p <0.05). The major risk predictors of mortality were apnea (OR=10.8), severe malnutrition (OR =6.9), sepsis (OR =7. I), deep surgical site infection (OR=3.5), and re-operation (OR=2.9). 

Conclusion: Neonatal surgical mortality is high at 26.2%. Significant mortality risk factors include prematurity, apnea, malnutrition, and sepsis.

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Author Biography

Hyginus Okechukwu Ekwunife, Nnamdi Azikiwe University Teaching Hospital, Nnewi Anambra State Nigeria

 

Emmanuel Ameh: Department of Surgery, National Hospital Abuja

Lukman Abdur-Rahman: Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital

Adesoji Ademuyiwa: Department of Surgery, College of Medicine, University of Lagos

Emem Akpanudo: Department of Surgery, University of Uyo Teaching Hospital Uyo

Felix Alakaloko: Department of Surgery, Lagos University Teaching Hospital Lagos

Kefas Bwala: Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital Bauchi

Ifeanyichukwu Egbuchulem: Sub-Department of Paediatric Surgery, University of Nigeria Teaching Hospital Ituku-Ozalla Enugu

Sebastian Ekenze: Sub-Department of Paediatric Surgery, University of Nigeria Teaching Hospital Itukk-Ozalla

Uchechukwu Ezomike: Sub-Department of Paediatric Surgery, University of Nigeria Teaching Hospital Itukk-Ozalla

Faboya Omolara: Department of Surgery, Lagos State University Teaching Hospital Ikeja

Oluwaseun Ladipo-Ajayi: Department of Surgery, Lagos University Teaching Hospital Lagos

Taiwo Lawal: Department of Surgery University of Ibadan/University College Hospital, Nigeria

Christopher Lukong: Department of Surgery Usmanu Danfodiyo University Teaching Hospital Sokoto

Victor Modekwe: Department of Surgery, Nnamdi Azikiwe University/Nnamdi Azikiwe University Teaching Hospital Nnewi

Abdulrasheed Nasir: Department of Surgery University of Ilorin/University of Ilorin Teaching Hospital Ilorin

Chigbundu Nwokoro: Department of Surgery, Olabisi-Onabanjo University Teaching Hospital Sagamu

Dave Okafor: Department of Surgery Alex Ekwueme University Teaching Hospital Abakaliki

Philemon Okoro: Department of Surgery, University of Port Harcourt/ University of Port Harcourt Teaching Hospital Port Harcourt

Samson Olori: Department of Surgery, University of Abuja Teaching Hospital Gwagwalada

Emmanuel Orji: Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki

Justina Seyi-Olajide: Department of Surgery Lagos University Teaching Hospital Idi-Araba Lagos

Tunde Sholadoye: Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria

Oludayo Sowande: Department of Surgery, Obafemi Awolowo University Teaching Hospital Ile-Ife

Jones Taiwo: Department of Surgery, Federal Medical Centre Lokoja

Adebayo Tanimola: Department of Surgery, Obafemi Awolowo University Teaching Hospital Ile-Ife

Jideofor Ugwu: Department of Surgery, Nnamdi Azikiwe University/ Nnamdi Azikiwe University Teaching Hospital Nnewi

Omolara Williams: Department of Surgery, Lagos State University Teaching Hospital Ikeja

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Published

2022-01-09 — Updated on 2022-01-09

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How to Cite

1.
Ekwunife HO, Ameh E, Abdur-Rahman L, Ademuyiwa A, Akpanudo E, Alakaloko F. Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study. J Neonatal Surg [Internet]. 2022Jan.9 [cited 2022Jan.22];11:3. Available from: https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1029

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