8/17/2019 The Prevalence

1/4

The Prevalence, Patterns, and Causes of Deaths of Surgical Neonates at a tertiary care

hospital in Pune

Aim/ objectives:

The aim of this study is to report the prevalence, patterns and factors that influenced

morbidity and mortality of surgical neonate.

Also the study was aimed at key factors that needed the attention of the physician and the

constitution of ‘team neonate with surgeons to effectively address and resuscitate the vital

surgical disorders in neonates.

!ntroduction:

There has been steady improvement in outcome with low incidence of surgical neonatal

deaths in developed countries owing to a lot of factors, including well organi"ed surgical

neonatal intensive care units, availability of facilities and highly skilled personnel.#$% !n adeveloping country intrauterine diagnosis and fetal surgery are not feasible and outcome of

neonatal surgery is still very poor #&%.

'any studies have been conducted to classify the neonates as to the risk involved soon after

delivery or admission. Among these the most prominent are clinical risk inde( for babies

)*+!- score, *+! !!, score for neonatal acute physiology )A0-, score for neonatal acute

 physiology 1 perinatal e(tension )A002-, A0 !!, A002 !!, T!, ational institute

of child health and human development )!*334- score, the erlin score and eonatal

mortality prognosis inde( )'0!-.#567%

0rognostic systems established in surgical neonates are the 8aterston criteria, 'ontrealclassification and pit" risk grouping in assessing prognosis of child with esophageal atresia

with or without tracheo6esophageal fistula, reau( et al for babies with congenital

diaphragmatic hernia and i(on and Tawes for patients with small bowel atresia #96$%

'aterial and methods:

A prospective study was carried out which enrolled $& neonates between ;anuary &$$ and

4ecember &$&. The standard care of treatment was provided to all neonates. *linical

 parameters were sought with each admission such as irth and admission weight )

8/17/2019 The Prevalence

2/4

non parametric tests #either t6test )difference of mean- or chi6sBuare test )difference of

 proportion-% for calculating statistical association, if any.

RESULTS:

A total of $& neonates who weighed from $.D to 7.E kg )mean &.F G $.H kg-, aged between $and 5 days )mean F.5 G &.H days-, comprising of 95 males and 5E females with male: female

ratio $.9: $ were managed during the period. A total of D5 deaths were recorded, giving a

 prevalence rate of D&.&@ among the neonates. Among the neonates who failed to survive,

9&.$@ were males and 5H.E@ females.

8/17/2019 The Prevalence

3/4

4iscussion:

The prevalence of death of surgical neonates owing to nutritional problems and late referrals

is still very high. The causes of deaths of surgical neonates are also multifactorial and the

death of any neonate may be due to a combination of many causes as revealed by this study

and other similar studies #$$%. The prevalence rate of mortality, D&.&@, recorded in this studyis high compared to results from developed countries where close to $@ survival rates are

recorded among surgical neonates #$%. ?esions of the gastrointestinal tract were the major

indication for neonatal surgery during the study period as similarly reported by other authors

#&%. *orrecting the compromised clinical conditions were difficult in many neonates, instead,

many of them continued to deteriorate. Cperating on such clinically compromised neonates

resulted in high mortality as reported by other authors #$&%.

*onclusion:

Though many scoring systems are available for neonatal mortality and morbidity prediction

are available, still high mortality prevalence prevails among the surgical neonates. ?ate

referrals which allowed resistant overwhelming sepsis to be established on arrival andnutritional problems of surgical neonates contributed to the high number of deaths.

There is a need to encourage early presentation of surgical neonates to hospital, timely

referrals, early resuscitative measures and above all a team for neonatal care is needed.

+eferences:

$. A"i" J, *hadwick ', 4ownton J eonatal taffing tudy *ollaborative

8/17/2019 The Prevalence

4/4

E. reau( *8 ;r, +ouse T', *ain 8,