Pattern and factors affecting management outcome of neonatal emergency surgery in Ile-Ife, Nigeria

Objective: To determine the pattern and various factors that can affect the outcome of emergency surgical management of the neonate in a developing country. Methods: A retrospective study of all neonates who had emergency surgery over a 10-year period at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Results: There were 72 males and 38 females. The age at presentation ranged between 2 h to 30 days (mean +/- SD: 6.62 +/- 7.14 days). The weight at presentation was 1.3 to 3.9 kg (mean +/- SD: 2.62 +/- 0.53 kg). The mean birthweight of the survivors (mean +/- SD: 2.84 +/- 0.44 kg) was significantly higher than those that died (mean +/- SD: 2.26 +/- 0.49 kg) (P<0.01). The mean interval to surgery from onset of symptoms in the survivors (mean +/- SD: 42.720 +/- 41.769 h) compared well to those that died (mean +/- SD: 51.85 +/- 65.52 h) (P= 0.424). The admission weight, duration of operation, level of gastrointestinal obstruction and type of operation significantly influenced the outcome. Closure of ruptured exomphalos, thoracostomy with oesophageal anastomosis, and intestinal resection with anastomosis are associated with high mortality. Sepsis/septicaemia was the commonest postoperative complications accounting for 16 deaths. Overall, there were 59 deaths (53.6%). Conclusion: The morbidity and mortality following emergency surgical management of the neonate is still very high in this environment. Lower admission weight, long duration of operation, type of operation performed and presence of upper gastrointestinal obstruction are significantly associated with increased neonatal surgical mortality in our hospital.