The presentation, surgical management and mortality of neonates with intestinal atresia in Mulago Hospital

Abstract

ABSTRACT Background: Intestinal atresia is one of the commonest causes of neonatal intestinal obstruction. Survival of neonates with intestinal atresia has improved in many developed countries but in low and middle income countries the mortality is still high. Objectives: The objective of this study was to describe the presentation, surgical management and determine the post-surgical mortality of neonates with intestinal atresia Mulago Hospital. Materials and methods: The study was a prospective cohort study carried out on neonates admitted with intestinal atresia and managed surgically in the pediatric surgical unit of Mulago hospital. They were followed up during the post-surgical period to either their death or discharge from the hospital depending on what came first Analysis: The data was entered using Epidata version 3.1 and analyzed using STATA version 12 software and the results presented inform of tables. Kaplan and Meyer curve was used to describe the time to mortality and associations were determined using the hazard ratio and the Cox regression analysis. Results: 29 neonates with neonatal intestinal atresia (NIA) were treated within the study period of one year, 17 (58.6%) of whom were males and 12 (41. 4%) were females. Mortality occurred in 17 (58.6%) with females being 5.68 times more likely to die than males. None of the neonates had stoma surgery. All the neonates were managed on the general ward and none being managed in a neonatal intensive care unit (NICU) and neither did they receive total parenteral nutrition (TPN). Discussion: The study is in keeping with most studies in Africa and other LMICs which found high mortality in neonates with NIA due to resource constrains. Conclusion: The mortality of neonates with NIA remains high in Mulago as long as the basic facilities for management of these neonates are lacking. Recommendations: Establishment of a NICU and provision of basic facilities to handle neonatal surgery so as to reduce on the high mortality in neonates with intestinal atresia. Further research on association of female sex to increased mortality following surgery for NIA is recommended.