Pattern of presentation of neonatal surgical disease and outcome of surgery at Kenyatta National Hospital

Abstract

Background; Neonatal surgery is the flagship subspecialty in paediatric surgery. Advances in neonatal resuscitation, neonatal anesthesia and neonatal transport have led to improved survival of the surgical neonate. In most centers a survival of greater than 90% is expected for the surgical neonate. Outcome of neonatal surgery is therefore a fair audit of the quality of paediatric surgical care. Study design: Prospective observational study Study Population: A sample size of 94 neonates admitted to the surgical units at the Kenyatta National Hospital (KNH) and all those who underwent surgery during the study period. Objective: To determine the pattern of presentation of neonatal surgical disease and outcomes of the neonatal surgery at the KNH Methodology: Ethical approval was obtained from the Kenyatta National Hospital (KNH/UON) Ethics and Research Review Committee. Patients who met the inclusion criteria were selected by non random progressive sampling. Informed consent was taken from parents/guardian. Data on patient biodata, gestational age, weight at birth and at admission, place of birth, application of principles of neonatal transport, prenatal diagnosis, surgical diagnosis and interventions and outcomes were collected using a pretested questionnaire. Additional data was obtained from the patient’s records. The data was entered on Excel spreadsheets and analyzed using Epi Info version 3.5.1. Mean median and mode as well as ranges, ratios and proportions were employed in analysis. Categorical data was analyzed using a Chi – square test and a p – value ≤0.05 is regarded as significant. The result has been presented in maps, tables, bar charts, pie charts and graphs. Results: Neonatal surgery was found to constitute 30.13% of the paediatric surgical workload. The commonest conditions are anorectal malformations (19.2%), anterior abdominal wall defects (17.2%), congenital heart defects (14.4%) and neural tube defects (9.6%). Overall mortality was 33% and the average length of stay was 10.2 days Conclusion: ARM is the commonest condition in the neonatal surgical unit at KNH. Though comparable to what has been found in some developing countries, neonatal surgical mortality is still unacceptably high at the hospital

Recommendations: Investment in neonatal care is mandatory to achieve better outcomes. This includes prenatal diagnosis, neonatal transport and preterm care.