Neonatal anesthesia in low birth weight babies at Hospital Nacional Guido Valadares, Dili, Timor-Leste

Over a 6-month period, eight neonates weighing less than 3 kg were operated on at Hospital Nacional Guido Valadares, Dili, Timor-Leste. Each was operated on for an abdominal condition. There is no postoperative neonatal ventilation, neonatal inotropes, fluid warmers, or parenteral nutrition available at Hospital Nacional Guido Valadares. Medical air and nitrous oxide are unavailable. Oxygen from cylinders is the only gas available in theaters and on the wards. Generally equipment is problematic and not designed for neonates. Five of these infants perished in hospital perioperatively, representing an in-hospital mortality of 62%, another is presumed to have died following discharge, and two recovered well. This represents an estimated overall mortality rate of 75%. This is not surprising given the difficult circumstances in theater and the limited postoperative support services available. The resources and time deployed in operating on these small neonates is significant. As difficult as it may be surgical enthusiasm and the uncertainties surrounding prognostication should not displace practical and realistic assessment of the likely outcome of operating on very small babies in low resource facilities where perioperative support is limited. Future development in the Timor-Leste healthcare sector will hopefully provide an environment where improvements in outcome can be achieved.