Factors associated with mortality in neonatal surgical emergencies in a developing tertiary hospital in Nigeria


Background: The outcome of neonatal surgery depends on safe anaesthesia, competent surgery and good nursing care. The University of Uyo Teaching Hospital, Uyo, Nigeria, established in February 2008, has specialist anaesthetic and surgical manpower. The aim of the study was to determine the outcome and contributing factors to mortality in neonatal surgical emergencies at this new tertiary health institution. Method: It was a retrospective descriptive study of neonates that underwent emergency surgery at the University of Uyo Teaching Hospital between June 2008 and May 2011. Data was obtained from the anaesthetic register, ward admission and discharged register, nurses report books and patient case files. Results: Forty-five neonates were operated upon during the three year period. There were 28 males and 17 females with a male to female ratio of 1.7:1. Forty-four (97.8%) of the neonates were referred to the University of Uyo Teaching Hospital. The mean age and body weight at presentation were 47.5 ± 44.4 hours and 2.65 ± 0.61 kg respectively. The mean interval between admission and surgical intervention was 4.9 ± 6.2 days. Malformations of the gut (40%) and anterior abdominal wall (26.7%) were the major pathologies. The overall mortality following surgery was 62.2%. Case fatality rates ranged from 0% for Hirschprung’s disease to 100% for tracheoesophageal fistula. The immediate causes of death among these neonates were peritonitis from gangrenous gut, hypovolaemia and repeat surgery. Contributing factors to mortality were delivery in unorthodox health facilities, delay in presentation as well as surgical intervention and inefficient postoperative monitoring. Conclusion: Emergency neonatal surgeries at the UUTH are associated with unacceptable high mortality. Reduction in such mortality would require campaign for early presentation, a lot more timely surgical interventions and upgrading of monitoring facili- ties to help in improving perioperative monitoring and care.

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Ilori, I. , Ituen, A. and Eyo, C. (2013) Factors associated with mortality in neonatal surgical emergencies in a developing tertiary hospital in Nigeria. Open Journal of Pediatrics, 3, 231-235. doi: 10.4236/ojped.2013.33040.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Rowe, M.I. and Rowe, S.A. (2000) The last fifty years of neonatal surgical management. The American Journal of Surgery, 180, 345-352. doi:10.1016/S0002-9610(00)00545-6
[2] Ameh, E.A., Dogo, P.M. and Nmadu, P.T. (2001) Emergency neonatal surgery in developing world. Paediatric Surgery International, 17, 448-451. doi:10.1007/s003830000551
[3] Lawn, J.E., Cousens, S. and Zupan, J. (2005) 4 million neonatal deaths: When? Where? Why? Lancet, 365, 891-900. doi:10.1016/S0140-6736(05)71048-5
[4] Tenge-Kuremu, R., Kituyi, P.W., Tenge, C.N. and Kerubo, J. (2006) Neonatal surgical emergencies at moi teaching and referral hospital in Eldoret-Kenya. East and Central African Journal of Surgery, 12, 36-39.
[5] Mouafo Tambo, F.F., Chiabi, A., Ngowe Ngowe, M., Ze Minkande, J., Andze, O.G. and Sosso, M. (2011) Mortality of neonatal surgical emergencies at the gynecologyobstetric and pediatric hospital of Yaounde, Cameroon. Medecine Tropicale, 71, 206-207.
[6] Osifo, D.O. and Oriaifo, I.A. (2008) Factors affecting the management and outcome of neonatal surgery in Benin City, Nigeria. European Journal of Pediatric Surgery, 18, 107-110. doi:10.1055/s-2008-1038485
[7] Faponle, A.F., Sowande, O.A. and Adejuyigbe O. (2004) Anaesthesia for neonatal surgical emergencies in SemiUrban Hospital in Nigeria. East African Medical Journal, 81, 568-573.
[8] Abubakar, A.M. and Ofoegbu, C.P.K. (2003) Factors affecting outcome of emergency paediatric abdominal surgery. The Nigerian Journal of Surgical Research, 5, 85-91
[9] Osifo, O.D. and Ovueni, M.E. (2009) The prevalence, patterns, and causes of deaths of surgical neonates at two African referral pediatric surgical centers. Annals of Pediatric Surgery, 5, 194-199.
[10] Gangopadhyay, A.N., Upadhyaya, V.D. and Sharma, S.P. (2008) Neonatal surgery: A ten-year audit from a university hospital. Indian Journal of Paediatrics, 75, 1025-1030. doi:10.1007/s12098-008-0205-4
[11] Asuquo, E.E.J., Etuk, S.J. and Duke, F. (2000) Staff attitude as barrier to the utilisation of University of Calabar Teaching Hospital for obstetric care. African Journal of Reproductive Health, 4, 69-73. doi:10.2307/3583450
[12] Osubor, K.M., Fatusi, A.O. and Chiwuzie, J.C. (2006) Maternal health-seeking behaviour and associated factors in a rural Nigerian community. Maternal and Child Health Journal, 10, 159-169. doi:10.1007/s10995-005-0037-z
[13] Udoma, E.J., Ekanem, A.D., Abasiattai, A.M. and Bassey, E.A. (2005) Reasons for preference of delivery in spiritual church-based clinic by women in South-South Nigeria. Nigerian Journal of Clinical Practice, 11, 100-103.
[14] Kamal, A., Khan, K., Rahman, I. and Khan, A. (2010) Small gut atresia in neonates. Journal of Ayub Medical College, Abbottabad, 22, 64-66.
[15] Ademuyiwa, A.O., Sowande, O.A., Ijaduola, T.K. and Adejuyigbe, O. (2009) Determinants of mortality in neonatal intestinal obstruction in Ile Ife, Nigeria. African Journal of Paediatric Surgery, 6, 11-13. doi:10.4103/0189-6725.48568
[16] Amponsah, G. (2010) Challenges of anaesthesia in the management of the surgical neonates in Africa. African Journal of Paediatric Surgery, 7, 134-139. doi:10.4103/0189-6725.70410
[17] Surgical Services of the Newborn (1999) Report of British Association of paediatric surgeons in collaboration with the Royal College of Surgeons of England. www.baps.org.uk
[18] Rami, S., Kler, N. and Kaur, A. (2012) Where should surgical neonates be nursed? Journal of Neonatal Surgery, 1, 24.
[19] Simiyu, D.E. (2003) Morbidity and mortality of neonates admitted in general paediatric wards at Kenyatta National Hospital. East African Medical Journal, 80, 611-616

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