Challenges of neonatal surgery at CHUK

Abstract

Introduction Africa has one of the highest neonatal mortalities in the world, for which the commonest causes include surgical conditions such as some congenital anomalies that are amenable to surgery but are not often operated on because of a number of challenges. These challenges include cultural beliefs and practices, lack of human resource capacity, inadequate laboratory and imaging support and lack of consumables and intensive or high dependency care facilities 20. Methods This was a prospective descriptive observational study assessing challenges met in management of neonates with surgical conditions. Neonates entered in the study at admission in pediatric emergency were those with most common neonatal surgical conditions which are: Anorectal malformations (ARM), gastrointestinal (GIT) Atresias, Omphalocele, Gastrochisis, Hirshprung disease, and congenital diaphragmatic hernia. Patient’s age, gender, vitals, diagnosis, imagery and laboratory findings were recorded. Follow up included management, complications and outcome. Results Over a 7-month period, there were 90 patients enrolled in the study with 58(64.4%) males and the rest 32( 35.6%) females. The large number of neonates in our study were born at health centers (55.6%) and district hospitals (38.9%). The time between birth and arrival at CHUK was between 0-30 days with the mean of 4.6 days. Most neonates in the study had diagnosis of anorectal malformation (34.4%) followed by GIT Atresias (21.1%), omphalocele (17.8%), gastrochisis (13.3%),Hirshprung disease (8.9%) and congenital diaphragmatic hernia (4.4%). Forty-eight (53.3%) neonates in our study underwent operation in OR while 26(28.9%) were managed non-operatively. Sixteen (17.8%) were not managed at CHUK: some have been counter referred and others died before proposed management. Among 90 neonates included in our study, 12(13.3%) died and 78 (86.3%) were discharged. 59(65.6%) were given appointment to be followed as outpatient, 17(18.9%) were discharged for palliative care at nearest health facility and 2(2.2%) were referred to another tertiary hospital (one at KFH, another at RMH)