Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study
Keywords:Neonatal surgery, Complications, Mortality, Predictors, Quality improvement
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.
World Health Organisation. SDG 3: Ensure healthy lives and promote wellbeing for all at all ages. Available at www.who.int/sdg/targets/en/. Accessed June 24, 2020.
UNICEF. Child survival and the SDGs. Available at data.unicef.org/topic/child-survival/child-survival-sdgs/. Accessed June 24, 2020.
Oza S, Lawn JE, Hogan DR, Mathers C, Cousens SN. Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000–2013.Bulletin of the World Health Organization 2015; 93:19-28. Available at https://www.who.int/bulletin/volumes/93/1/BLT-14-139790-table-T2.html.
Woods D, Aldous C, Christianson A, Malherbe HL. The contribution of congenital disorders to child mortality in South Africa. South Afr Heal Rev. 2016; 1:137-52.
UNICEF. Neonatal mortality rate. UNICEF global database. Available at https://data.unicef.org/wp-content/uploads/2017/10/Neonatal-mortality-rate_2020.xlsx. Accessed September 27, 2020.
Lohfa B Chirdan, Petronila JN, Essam A Elhalaby. Neonatal surgery in Africa. Semin Pediatr Surg. 2012; 21:151-9.
Ameh EA, Seyi-Olajide JO, Sholadoye TT. Neonatal surgical care: a review of the burden, progress and challenges in sub-Saharan Africa. Paediatr Int Child Heal. 2015; 35:243-51.
Ilori IU, Ituen AM, Eyo CS. Factors associated with mortality in neonatal surgical emergencies in a developing tertiary hospital in Nigeria. Open J Paediatr. 2013; 3:35890. Available from https://doi.org/10.4236/ojped.2013.33040.
Ekwunife OH, Okpata A, Ugwu JO, Osuigwe AN. Outcome of neonatal surgeries in Nnewi, Nigeria. Ann Pediatr Surg. 2015; 11:132-5.
Ugwu RO, Okoro PE. Pattern, outcome and challenges of neonatal surgical cases in a tertiary teaching hospital. Afr J Paediatr Surg. 2013; 10:226-30.
Ekenze SO, Ajuziogu OV, Nwomeh BC. Neonatal surgery in Africa: a systematic review and meta-analysis of challenges of management and outcome. Lancet. 2015; 385:S35.
American College of Surgeons. Paediatric ACS NSQIP operations manual 2015. Available from https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.facs.org/~/media/files/quality%2520programs/nsqip/nsqip_puf_user_guide_2015.ashx&ved=2ahUKEwj5iKrgo5n1AhVNzBoKHb4QA74QFnoECAYQAQ&usg=AOvVaw25Y_eUNTPGjYy9iQiq5Cqo
Aiwanlehi E, Ogbaisi E. Pattern of neonatal surgery at a teaching hospital in Nigeria: A review of 101 cases. East Cen Afr J Surg. 2013; 18:56-60.
Sample size calculator. Available from: www.surveysystem.com/sscalc.html.
Yagi M, Kohno M, Asagiri K, Ikeda T, Okada T, Kanada S, et al. Twenty-year trend in neonatal surgery based on a nationwide Japanese surveillance program. Pediatr Surg Int. 2015; 31:955-62.
Livingstone MH, Cruz J, Pemberton J, Ozgediz Z, Poenaru D. Mortality of pediatric surgical conditions in low and middle income countries. J Pediatr Surg. 2015; 50:760-4.
Nandi B, Mungongo C, Lakhoo A. A comparison of neonatal surgical admissions between two linked surgical departments in Africa and Europe. Pediatr Surg Int. 2008; 24 :939-42.
Manson J, Ameh E, Canvassar N, Chen T, Hoeve A, Lever F, et al. Gastroschisis: A multi-centre comparison of management and outcome. Afr J Paediatr Surg. 2012; 9:17-21.
Wesonga A, Situma M, Lakhoo K. Reducing gastroschisis mortality: A quality improvement initiative at a Ugandan Paediatric Surgery Unit. World J Surg. 2020; 44:1395-9. Available from: https://doi.org/10.1007/s00268-020-05373-w.
Hassan MS, Rahman A, Huq U. Neonatal surgical mortalities in developing countries: Can it be a barrier to achieving sustainable development goals (SDG). Int J Pediatr Child Care. 2019; 1:1-4.
Ademuyiwa AO, Sowande OA, Ijaduola TK, Adejuyigbe O. Determinants of mortality in neonatal intestinal obstruction in Ile Ife, Nigeria. Afr J Paediatr Surg. 2009; 6:11-3.
Mitul AR. Surgical neonatal sepsis in developing countries. J Neonatal Surg. 2015; 4:41.
Ekenze SO, Ajuzieogu OV, Nwomeh BC. Challenges of management and outcome of neonatal surgery in Africa: A systematic review. Pediatr Surg Int. 2016; 32:291-9. Available from: https://doi.org/10.1007/s00383-016-3861-x.
Ameh EA, Ameh N. Providing safe surgery for neonates in Sub-Saharan Africa. Trop Doct. 2003; 33:145-7.
Amponsah G. Challenges of anaesthesia in the management of surgical neonates in Africa. Afr J Paediatr Surg. 2010; 7:134-9.
National Surgical, Obstetrics, Anaesthesia & Nursing Plan (NSOANP) for Nigeria: Strategic Priorities for Surgical Care (StraPS) (2019-2023) [Internet]. Federal Ministry of Health, Nigeria; 2019 [cited 2020 Aug 17]. Available from: http://health.gov.ng/doc/NSOANP.pdf.
Akinmoladun JA, Anumba DO. Fetal imaging and diagnosis services in developing country- A call to action. Trop J Obstet Gynaecol. 2019; 36:11-7.
Ameh EA, Adejuyigbe O, Nmadu PT. Paediatric surgery in Nigeria. J Pediatr Surg. 2006; 41:542-6.
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Copyright (c) 2022 Hyginus Okechukwu Ekwunife, Emmanuel Ameh , Lukman Abdur-Rahman , Adesoji Ademuyiwa , Emem Akpanudo , Felix Alakaloko , Kefas Bwala, Ifeanyichukwu Egbuchulem , Sebastian Ekenze , Uchechukwu Ezomike , Faboya Omolara , Oluwaseun Ladipo-Ajayi , Taiwo Lawal, Christopher Lukong , Victor Modekwe , Abdulrasheed Nasir , Chigbundu Nwokoro , Dave Okafor , Philemon Okoro , Samson Olori , Emmanuel Orji, Justina Seyi-Olajide , Tunde Sholadoye , Oludayo Sowande, Jones Taiwo , Adebayo Tanimola, Jideofor Ugwu, Omolara Williams
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