Neonatal surgery: Demand and survival both are on increase- an experience of seventeen years in Dhaka Medical College Hospital, Bangladesh

Abstract

Background: In order to achieve the Sustainable Development Goal (SDG) 3 target of reduction in under-five mortality below 25 per thousand live births by the year of 2030, major reductions are going to be required in neonatal mortality. Congenital anomalies have become the fourth cause of neonatal deaths and most of these are curable. The largest public hospital of Bangladesh is serving the poor and lower middle class people where surgery and medical facilities are mostly free of cost. Objective: This study was done to assess the types of neonatal surgical patients admitted in this hospital and their management outcome with limited facilities and explore new ideas and information and the ways to improve the scenario to contribute in achieving the SDG 3. Methods: This was a descriptive study with retrospective record review of all admitted neonates done over a period of 17 years from July 2001 to June 2018 and carried out in the Department of Paediatric Surgery. A total of 2492 neonates were admitted during this period and it was the 16.16% of total number of 15414 paediatric surgical admission upto 12 years of age. Data were collected from hospital records and analysed retrospectively. Detail history of each patient was collected and recorded in a pre-designed, semi-structured questionnaire. Statistical analyses were done by SPSS version 22. Results: Out of these 2492 neonates, 1932 (77.53%) were admitted for Neonatal Intestinal Obstruction (NIO) and intestinal atresia 246 (09.87%), omphalocele 163 (06.54%), meconium ileus 154 (06.18%), volvulous neonatoram 125 (05.02%), septicemia 114 (04.57%), posterior urethral valve 78 (03.13%), gastroschisis 75 (03.01%), abscess 57 (02.29%), congenital Diaphragmatic Hernia 54 (02.17%), ectopia vesicae 50 (02.01%), infantile pyloric stenosis 42 (01.68%), tracheo-oesophageal fistula 24 (0.96%), prune belly syndrome 8 (0.32%), neonatal injury 5 (0.20%), conjoint twin 4 (0.16%). The most common cause of NIO was anorectal malformation (ARM) 806 (32.34%). And/of them 516 (64.02%) patients had high variety and 290 (35.98%) patients had low variety ARM. Next was Hirschsprungs disease and 487 (19.54%) neonates presented with this. One hundred and forteen (4.57%) patients presented with septicemia and 246 (9.87%) presented with intestinal atresia, 154 (6.18%) neonates had meconium ileus and 125 (5.02%) patients presented with volvulus neonatorum. Total 1791 (71.86%) patients were managed surgically. Most of the surgerical procedures were pelvic colostomy 541 (21.71%), transverse colostomy and biopsies 376 (15.09%), resection and anastomosis 261(10.47%), anoplasty 239 (9.59%), primary repair 135 (5.42%) and ileostomy 104(4.17%). Out of 2492 patients, 351 died, so mortality rate was 14.09%, before surgery 127 (5.10%) and after surgery was 224 (14.85%). Conclusion: Paediatric surgeons by their skills and teamwork greatly improved the neonatal surgical service and contributing significantly in reducing infant mortality rate to achieve SDG 3. But to improve further, neonatal intensive care unit (NICU) and other support systems are essential as well as support from UNICEF and World Health Organization (WHO) to include paediatric surgery and surgeons in their activities especially in developing countries. Due to socio-political and economic reasons of the developing countries the roll of paediatric surgeons are multidimensional.