An analysis of neonates with surgical diagnoses admitted to the neonatal intensive care unit at Charlotte Maxeke Johannesburg Academic Hospital

Abstract

Introduction: The burden of neonatal surgical conditions is not well documented in lower to middle income countries (LMICs), yet neonatal surgical conditions are thought to be relatively common with a considerable proportion of neonates admitted to the neonatal intensive care unit (NICU) requiring surgical intervention. The NICU at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) is combined with a paediatric intensive care unit, to a total of 15 beds, and serves as a referral hospital. Objectives: To review neonates with surgical conditions admitted to the Neonatal Intensive Care Unit (NICU) in our hospital setting. Methods: This was a retrospective, descriptive study of neonates admitted to the NICU at CMJAH with surgical conditions between 1 January 2013 and 31 December 2015. The characteristics and the survival of these neonates were described using univariate analysis. Results: There were 923 neonates admitted to the NICU, of which 319 (34.6%) neonates had primarily surgical conditions. Of the 319 neonates, 205 survived (64.3%). There were 125/319 (39.2%) neonates with necrotizing enterocolitis (NEC), 55 of whom survived (55/125, 44.0%), making the presence of NEC significantly associated with poor outcome (p=<0.001). Other significant predictors of poor outcome were: the patient being outborn (p=0.029); the presence of late sepsis (p=<0.001) – with Gram-negative (p=0.005) organisms; as well as lesser gestational age (p=0.001) and lower birth weight (p=<0.001). Major birth defects were present in 166/319 (52.0%) of neonates. Conclusions: Neonates with major surgical conditions account for one third of NICU admissions in the present study. Paediatric surgical services, with a proper referral and neonatal transport system, must be a priority in planned healthcare interventions to reduce neonatal mortality in LMICs. (Word count 269)