Early postoperative morbidity and mortality in neonatal intestinal obstruction: Predictors and challenges in a low-income country

Abstract

Objectives

Preventable complicated outcomes and death from neonatal intestinal obstruction (NIO) need to be identified with insights into how to improve survival. This study aimed to evaluate the incidence and predictors of early postoperative morbidity and mortality (EPMM) in NIO.

Material and methods

Charts of neonates with NIO operated between 2013 and 2023 were reviewed. The primary outcomes were the incidence of EPMM within 30 days. The secondary outcomes were the evaluation of the relationship between explanatory variables and EPMM using univariate and multivariate logistic regression.

Results

A total of 130 newborns were enrolled in the study. The most common etiology of NIO was anorectal malformations. Forty two patients (32.3%) presented associated congenital anomalies. The mean age at surgery was 4 days. The mean duration of the intervention was 105 min. The 30-day morbidity and mortality rates were, respectively, 36.5% and 23.1%. Sepsis was the most important postoperative complication. The independent risk factors of postoperative morbidity were the presence of associated malformations (p = 0.011, OR = 2.728, CI [1.255–5.931]) and prolonged duration of surgery (p = 0.039, OR = 2.361, CI [1.044–5.340]). The independent risk factors of early mortality were the low birth weight (p < 10–3, OR = 5,907, CI [2241–15,574]) and the prolonged duration of surgery (p = 0.009, OR = 3,643, CI [1381–9608]).

Conclusion

This study underscores the high burden of EPMM in NIO from LICs. Sepsis, associated malformations, low birth weight, prematurity, and prolonged surgery were major contributors. Addressing these challenges through improved perioperative care, infection control, and healthcare infrastructure may improve outcomes in such settings.