Neonatal gastrointestinal surgical emergencies: a 5- year review in a teaching hospital Addis Ababa, Ethiopia.

Objective: A five year retrospective review of medical records of newborns admitted for gastrointestinal surgical emergencies was done. This study was intended to see the pattern of presentation, mode of intervention and surgical outcome of these cases and for provision of feed-back to the surgeon-pediatrician team who are involved in the care of such newborns. Methods: The study included cases admitted to the neonatal unit of the department of pediatrics and child health, Tikur Anbessa specialized Hospital, Addis Ababa, during the period of January 1, 1997 to December 31, 2001. Results: A total of 60 cases admitted during the above-mentioned period were reviewed. Thirty-six (60%) were males, 23(38%) were females, while one newborn had ambiguous genitalia. Imperforate anus has accounted for 27 (45 %) of the 60 cases; jejunoileal atresia and esophageal atresia with or without tracheoesophageal each accounted for 12(20 %) cases; while 9(15 %) had other lesions. Of the 60 cases surgical intervention was performed on 43 (72%) newborns. Of the 12 newborns with esophageal atresia with or with out tracheoesophageal fistula, only one newborn was discharged alive; 7 out of 12 newborns with jejunoileal atresia died, 4 cases discharged improved while the outcome for 1 newborn was not known. Of the newborns with imperforate anus, 8(47%) of the 17 with the high type and 1(10%) of the 10 with low-type died. Conclusion: Early diagnosis, availability of diagnostic service and prompt surgical intervention with optimal preand post-operative care are necessary to increase survival of newborns with such problems. 1 Department of Peadiatrics, Addis Ababa University, Medical Faculty, Addis Ababa 2 Department of Surgery, Medical Faculty, Addis Ababa University , Addis Ababa INTRODUCTION Neonatal gastrointestinal surgical emergencies may include conditions like esophageal atresia with or without tracheoesophageal fistula (EA±TEF); gastric volvulus; intestinal atresias, stenosis or malrotations; anorectal malformations; extrinsic intestinal obstruction like in ruptured omphalocele; or gastroschisis (1 11). Atresias can now be diagnosed antenatally using ultrasonographic techniques as early as 16-20 weeks of gestation (1, 6). Surgical intervention for such conditions has evolved along with the development of specialized neonatal care units (6). As a result conditions like esophageal atresia and intestinal atresia which were once, considered fatal, now carry survival chances of nearly 100% and more than 85% respectively (2,6). While the above achievements are true for the developed world, mortality rates as high as 75% are being reported from developing countries, where intensive preand post-operative management and neonatal care are below optimum (3). In Ethiopia, no published data is available on the presentation and outcome of such newborns. This study therefore attempts to see the pattern of presentation, mode of intervention and surgical outcome of newborns with gastrointestinal surgical emergency conditions at Tikur Anbessa Specialized Hospital (TASH), neonatal ward, over the period of January 1, 1997 to December 31, 2001. The data may serve as a stepping stone for future coordinated prospective studies, and for provision of feed-back for surgeonpediatrician team who are involved in the care of such newborns. MATERIALS AND METHODS The study was conducted in the neonatal ward of the Pediatric Department of Tikur Anbessa Specialized Hospital (TASH), where newborns of age up to 7 days are admitted. The Department of Pediatrics and Child Health has given permission to pursue the study. Medical records of newborns with gastrointestinal surgical emergency admitted during the period of January 1997 to December 2001 were retrospectively reviewed. Birth weight, sex, age at admission and death, presenting problems as well as clinical and radiological findings were reviewed. Age at intervention, type of intervention and final outcome were also reviewed. Delayed diagnosis for cases of EA±TEF in this study refers to a diagnosis that was made after the newborn is fed orally. Data was analyzed using EPI INFO version 6.