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Published on: September 20, 2019
Surgical neonates in a low-resource setting: Baseline nutrition and outcome assessment
Stella Nimanya1, Phyllis Kisa1, Fizan Abdullah2
1Mulago National Referral Hospital, Mulago Road, Kampala, Uganda and Makerere University, 7062 University Rd, Kampala, Uganda.
Insights
Neonatal surgery outcomes in Uganda show high mortality for gastroschisis, intestinal atresia, and esophageal atresia. Malnutrition and electrolyte imbalances are common, impacting survival rates for these critical congenital anomalies.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
- Global Health
Background:
- Congenital anomalies like gastroschisis (GS), intestinal atresia (IA), and esophageal atresia (EA) lead to high mortality in low-income settings, often due to malnutrition and electrolyte disturbances.
- Parenteral nutrition (PN) is crucial but often unavailable, necessitating accurate baseline data on morbidity and mortality for intervention development.
- This study quantifies peri-operative outcomes in neonates with these conditions in Uganda.
Purpose of the Study:
- To determine peri-operative morbidity and mortality in neonates with gastroschisis, intestinal atresia, and esophageal atresia in Uganda.
- To assess fluid and electrolyte disturbances, and growth patterns in this vulnerable neonatal population.
- To establish a baseline for evaluating future interventions aimed at improving survival rates.
Main Methods:
- A prospective cohort study of 45 neonates treated between October 2021 and March 2022 in Uganda.
- Standardized care included protocolized fluid and nutrition, vital signs monitoring, and routine laboratory measurements.
- Statistical analysis involved Fischer's exact tests, logrank tests, and Cox proportional hazards models to compare survivors and non-survivors.
Main Results:
- The study included 28 (62.2%) GS, 4 (8.9%) EA, and 13 (28.9%) IA cases. Overall survival to discharge was 36% (26% GS, 50% EA, 54% IA).
- Average length of stay was 17.3 days for survivors and 9 days for non-survivors. Average birth weight was 2.21 kg, with no significant weight change.
- Abnormal serum sodium was observed in 64%, phosphate in 36.5%, and magnesium in 20.8% of measurements. Mortality did not correlate with diagnosis, electrolyte derangement, or weight change.
Conclusions:
- Neonates with gastroschisis, esophageal atresia, and intestinal atresia face high mortality rates in Uganda.
- Malnutrition and fluid/electrolyte derangements are prevalent and likely contribute to mortality.
- The findings provide essential comparative data for developing interventions to improve outcomes for these high-risk neonatal surgical conditions.
Introduction:
Congenital anomalies necessitating prolonged fasting have a high mortality in low-income settings, partially due to malnutrition and electrolyte disturbances in the absence of parenteral nutrition (PN). Interventions to address these problems require an accurate baseline quantification of the morbidity and mortality of this population. This prospective study aimed to determine peri-operative morbidity, fluid and electrolyte disturbance, growth, and mortality in neonates with gastroschisis (GS), intestinal atresia (IA), and esophageal atresia (EA) in Uganda.
Methods:
Standardized patient care of 45 neonates treated in Uganda from Oct 2021 to March 2022 with protocolized fluid and nutrition, vital signs, and routine laboratory measurements. Patient demographics, admission and hospital characteristics are described with mean ± SD. Characteristics of survivors and non-survivors were compared with Fischer's exact tests, logrank tests, and CoX Ph model.
Results:
Twenty-eight (62.2%) patients had GS, 4 (8.9%) EA, and 13 (28.9%) IA. Thirty-six percent (16/44) of patients survived to discharge (26% GS, 50% EA, 54% IA) with an average length of stay of 17.3 days ( ± 2.2) (survivors) and 9 days ( ± 1.7) (non-survivors). Average weight was 2.21 kg ( ± 0.62) at presentation, with no significant weight change during the study. Abnormal serum sodium in 64%, phosphate 36.5%, and magnesium 20.8% of measurements. Mortality did not correlate with diagnosis (p = 0.47), electrolyte derangement, or weight change.
Conclusion:
Mortality of neonates born with GS, EA, and IA is high in Uganda. Malnutrition and fluid/electrolyte derangements are common and may affect mortality. This study provides a comparison group for studying interventions to improve outcomes for these populations.
Type Of Study:
Prospective cohort.
Level Of Evidence:
Level 3.
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