Outcomes of neonates requiring surgical interventions at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Neonatal surgical procedures are important in improving the outcomes of many diseases in neonates most of which are congenital anomalies. Timely intervention plays a major role in determining the success rates as well as improving outcomes. In order to be successful in managing neonates with surgical problems, a multidisciplinary approach is required with adequate medical supplies and resources availed in the right setting. Other co-morbid conditions including sepsis, respiratory distress and apnea have been found to affect outcomes. This study sought to find out the outcomes and factors influencing these outcomes in neonates with surgical conditions. Objective: To evaluate the outcomes (mortality and length of stay) of neonates with diseases that require surgical intervention at Moi Teaching and Referral Hospital. Methods: This was a prospective descriptive study carried out at Moi Teaching and Referral Hospital New Born Unit. A total of 124 neonates with conditions requiring surgical intervention were recruited into the study. Data was collected at the point when the decision was made for surgical intervention and recorded using a structured questionnaire. The spectrum of conditions and factors influencing outcomes were recorded until discharge or mortality and length of stay determined. Data analysis was done using STATAR version 13 at 95% confidence interval. Data was presented in frequency tables, pie charts and graphs. Descriptive statistics was used for continuous variables. Logistic regression and Mann Whitney U test were also done. A p-value of less than 0.05 was considered statistically significant. Results: A total of 124 participants were recruited between February and November 2016. The number of males was 66(53.2%) with a male to female ratio of 1.1:1. The median age at admission to the newborn unit was 2 days (IQR 1,5). The leading neonatal surgical conditions were gastroschisis at 33(26.6%), neural tube defects 25(20.2%) and ARM 25(20.2%). The overall mortality rate was 31.5%(39). The number of neonates discharged home was 83(66.9%) with 2(1.6%) being referred to KNH. Majority of neonates 103(83.1%) came in as referrals from peripheral health facilities. Most neonates 74(59.7%) had a birth weight of 2.5-3.9kgs. Antenatal clinic attendance was protective of mortality (OR 0.126; 95% CI 0.025-0.6429; p= 0.013). Sepsis, respiratory distress and electrolyte imbalance were associated with increased odds of mortality at (OR 3.4; 95% CI 1.09-22.06; p=0.049), (OR 4.9; CI 0.91-11.61; p=0.001) and (OR 3.1; CI 1.21-31.60; p=0.029) respectively. The median length of hospital stay was 14.5 days with a range of 0-102 days. There was an association between time to initiation of feeds post operatively and length of stay p= 0.0071. Conclusion The overall mortality was 31.5%. The length of hospital stay was long. Gastroschisis was the leading neonatal surgical condition. Sepsis and electrolyte imbalance were associated with mortality. Recommendation Effective management of sepsis and electrolyte imbalance will improve on outcomes. Early initiation of appropriate feeding in the post-operative period.