Outcome and factors associated with mortality of neonates with surgical conditions at Mulago National Referral Hospital.

Abstract

Background: Surgery of neonates is a major challenge worldwide and especially in low and middle income countries where mortality due to surgical conditions has remained high. In developed countries, there has been remarkable improvement in the management and outcome of neonatal surgical conditions over the last fifty years mainly attributed to the advancements in technology and the availability of neonatal intensive care unit (ICU) services. These services are not readily available in Uganda and the actual magnitude of neonatal surgical conditions is unknown. The aim of this study was to establish the outcomes and factors associated with mortality of neonates with surgical conditions admitted at Mulago National Referral Hospital. Methods: This was a hospital based prospective cohort study carried out at Mulago National Referral hospital whereby all neonates with surgical conditions that presented to the hospital were recruited after obtaining consent from their parents. A semi-structured pretested questionnaire was used to collect data on the neonatal and maternal characteristics, the patient’s clinical presentation, diagnosis and laboratory findings. The patients were then followed up on their wards until they either attained an outcome or became 28 days old. The collected data was then entered into EPIDATA Version 3.1, coded and transferred to STATA Version 12 for analysis. Results: A total of 76 neonates were recruited with a male to female ratio of 1.4:1. 64% of the neonates were less than one week old. The commonest presenting complaint was failure to pass stool at 40.8% with the gastrointestinal conditions being the commonest. Mortality ratio of 32.9% was recorded with intestinal atresia being the single most lethal condition with 100% mortality. The other outcomes were discharge at 42%, still on ward at 9%, DAMA 7% and runaway at 4%.Gestation age was found to have an association with mortality (p= 0.009). There was no significant correlation between mortality from neonatal surgical condition and all the other factors.