Clinical profile, outcomes and predictors of mortality in neonates operated for gastrointestinal anomalies in a tertiary neonatal care unit- An observational study
Journal – Journal of Indian Association of Pediatric Surgeons
Article type – Journal research article – Clinical research
Publication date – May – 2022
Authors – Antony Leo Jerry, Prakash Amboiram, Umamaheswari Balakrishnan, Ashok Chandrasekaran, Prakash Agarwal, Usha Devi
Keywords – Gastrointestinal tract, growth, malformations, mortality, Neonate
Open access – Yes
Speciality – General surgery, Paediatric surgery
World region Southern Asia
Language – English
Submitted to the One Surgery Index on May 22, 2022 at 5:59 am
Background: Gastrointestinal (GI) malformations have varied short-term and long-term outcomes reported across various neonatal units in India.
Methods: This descriptive study was done to study the clinical profile, outcomes and predictors of mortality in neonates operated for congenital GI malformations in a tertiary neonatal care unit in South India between years 2011 and 2020. Details were collected by retrospective review of the case sheets.
Results: Total of 68 neonates were included with esophageal atresia (EA) in 10, infantile hypertrophic pyloric stenosis (IHPS) in 9, duodenal atresia (DA) in 10, ileal atresia in 8, jejunal atresia in 5, anorectal malformations (ARM) in 11, meconium ileus/peritonitis in 9, malrotation in 2, and Hirschsprung’s disease (HD) in 4. Antenatal diagnosis was highest in DA (80%). Associated anomalies were maximum in EA (50%), the most common being vertebral, anal atresia, cardiac defects, tracheoesophageal fistula, renal and radial abnormalities, and limb abnormalities association (VACTERL). Overall mortality was 15%. IHPS, DA, Malrotation, HD and ARM had 100 % survival while ileal atresia had the least survival (38%). Gestational age <32 weeks (odds ratio [OR] 12.77 [1.96, 82.89]) and outborn babies (OR 5.55 [1.01, 30.33]) were significant predictors of mortality in babies operated for small intestinal anomalies. None of the surviving infants were moderately or severely underweight at follow-up.
Conclusion: Overall survival of surgically correctable GI anomalies is good. Among the predictors for mortality, modifiable factors such as in-utero referral of antenatally diagnosed congenital anomalies need attention. One-fifth had associated anomalies highlighting the need to actively look for the same. Although these neonates are vulnerable for growth failure, they had optimal growth on follow-up possibly due to standardized total parenteral nutritional policy during neonatal intensive care unit stay.
OSI Number – 21611