Trends in neonatal intestinal obstruction in a developing country, 1996-2005

Despite the advances in neonatal surgery, the outcome of neonatal intestinal obstruction (NIO) in many developing countries has been reported to be poor. This study describes the trends in NIO, including the contributory factors in southeast Nigeria.

We performed a comparative analysis of 128 consecutive NIO managed from January 1996 to December 2005 at the University of Nigeria Teaching Hospital, Enugu, in southeast Nigeria.

Fifty-five (43.0%) neonates were managed in the first 5 years (group A) and 73 (57.0%) in the last 5 years (group B). Etiology of obstruction did not vary significantly in the two groups. Average duration of symptoms before presentation fell from 5.9 days (group A) to 4.7 days (group B). With exception of Hirschsprung's disease (HD), all other cases required operative treatment. In HD, colostomy rate declined from 44.4% (group A) to 26.7% (group B). More neonates in group B were managed with general anesthesia and perioperative third-generation cephalosporin antibiotics (p < 0.01). While complication rate did not vary significantly in the two groups (group A, 42%; group B, 40.3%), survival improved (group A, 61.8%; group B, 72.6%). Earlier presentation, improved manpower, and use of potent antibiotics may have contributed to the improved outcome. Challenges in the form of lack of neonatal intensive care facilities and dearth of qualified personnel persist.

There is a trend toward earlier presentation and increased survival of babies with NIO in our setting. Improving the existing facilities and trained manpower, and establishing collaboration with centers that have excellent results may further encourage the trend.