Abdominal surgery in very low birth weight neonates in a developing world neonatal unit- Short term outcomes and risk factors for mortality

Master Thesis


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Background The surgical infant requires care in specialized neonatal units. Very low birth weight (VLBW) infants are a group particularly vulnerable to the risks and outcomes associated with preterm birth. There is an increased number of abdominal emergencies seen, attributed to improved survival in this birthweight category. Objectives To describe the short-term survival to discharge in VLBW infants following abdominal surgery at a South African public tertiary hospital and to examine the utility of common scoring systems for prognostication. Methods A retrospective study of VLBW infants with abdominal surgery was conducted in patients admitted to the neonatal unit at Groote Schuur Hospital between 2012 and 2016. CRIB and SNAPPE scores were calculated for patients where sufficient data was available. Results Fifty-two patients were included. The mean gestational age (GA) and birthweight (BW) were 29.5 weeks (SD 2.1) and 1102g (SD 197.8) respectively. Necrotizing enterocolitis was the most common (50%) surgical emergency. The leading postoperative complication was sepsis (37%). Fourty-two (81%) infants survived to discharge, the mean age at presentation 21 days (SD 21.1) with a mean hospital stay of 74 days in survivors vs 52 days in the non-survivors (p=0.06). There was no statistically significant difference in SNAPPE scores between survivors and non-survivors. Conclusion Abdominal emergencies have a high mortality and adds to the overall length of stay in VLBW infants. Neonatal scoring systems have proven to be useful adjuncts in predicting neonatal mortality, further study is warranted in infants who deteriorate due to surgical abdominal complications.