Emergency neonatal surgery in a developing country
| Autor: | Emmanuel A. Ameh, Dogo Pm, P. T. Nmadu |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Time Factors medicine.medical_treatment Nigeria Infant Newborn Diseases Congenital Abnormalities Postoperative Complications Intensive care Intensive Care Units Neonatal Pediatric surgery medicine Humans Local anesthesia Hospital Mortality Adverse effect Developing Countries Emergency Treatment Referral and Consultation Quality of Health Care Retrospective Studies business.industry Gastroschisis Colostomy Infant Newborn Retrospective cohort study General Medicine medicine.disease Treatment Outcome El Niño Pediatrics Perinatology and Child Health Emergency medicine Surgery Female business Intestinal Obstruction |
| Zdroj: | Pediatric surgery international. 17(5-6) |
| ISSN: | 0179-0358 |
| Popis: | With better understanding of neonatal physiology and improvements in diagnostic facilities and neonatal intensive care units (NICU), the outcome of neonatal surgery has improved in developed countries. In developing countries, however, neonatal surgery is problematic, particularly in the emergency setting, but there are few reports from these countries. A retrospective analysis of 154 neonates who had emergency surgery over a 10-year period at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, was undertaken. Emergency surgery represented 40% of surgical procedures in neonates in the hospital. The majority of the patients (94.8%) were delivered at home or in rural health centers. The median weight was 2.7 kg (range 2.0-3.7 kg). In 89 cases (58%) the indications for surgery were intestinal obstruction, anorectal malformations in 60(67%) and in 33(21%) complicated exomphalos or gastroschisis. Nine patients (6%) required surgery for ruptured neural-tube defects. A colostomy was the commonest procedure (51, 33%), 27(53%) of which were performed using a local anesthetic without adverse effects. Thirty-three abdominal-wall defects were closed by various methods (fascial closure 23, skin closure 6, improvised silo 4). Overall, 37 (24%) procedures were performed using local anesthesia. Fifty-nine patients (38%) developed postoperative complications (infections 33, respiratory insufficiency 16, colostomy complications 8, anastomotic leak 2). The mortality was 30.5%, 66% due to overwhelming infection, 28% to respiratory insufficiency, and 4.3% to multiple anomalies. Other factors considered to have contributed to morbidity and mortality were late referral and presentation and a lack of NICUs. Thus, emergency neonatal surgery is attended by high morbidity and mortality in our environment at the present time. Early referral and presentation and provision of NICUs should improve the outcome. |
| Databáze: | OpenAIRE |
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