1
|
Moges N, Ahmed K, Birhanu D, Belege F, Dimtse A, Kerebeh G, Kassa BD, Geta K, Oumer KE, Zewde EA, Dessie AM, Anley DT, Demis S, GebreEyesus FA, Bantie B. Surgical outcome and predictors of neonates with esophageal atresia admitted at Tikur Anbesa Specialized Hospital. PLoS One 2023; 18:e0285669. [PMID: 37192197 DOI: 10.1371/journal.pone.0285669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/27/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. This anomaly continues to cause considerable morbidity and mortality in Sub-Saharan Africa, presenting various concerns about how to treat esophageal atresia. Esophageal atresia-related neonatal mortality can be reduced by evaluating the surgical outcome and identifying associated factors. OBJECTIVE This study aimed to assess the surgical outcome and identify predictors of neonates with esophageal atresia admitted at Tikur Anbesa specialized hospital. METHODS Retrospective crossectional study design was employed on 212 neonates with esophageal atresia who were undergone surgical intervention in Tikur Anbesa specialized hospital. Data were entered into epi data 4.6 and exported to Stata version 16 software for further analysis. A logistic regression model with Adjusted odds ratio (AOR), confidence interval (CI) and p-value <0.05 were used to identify predictors of poor surgical outcome of neonates with esophageal atresia. RESULT In this study, 25% of newborns who underwent surgical intervention at TikurAbnbesa specialized hospital had successful surgical outcomes, compared to 75% of neonates with esophageal atresia who had poor surgical outcomes. Significant predictors of the poor surgical outcome of neonates with esophageal atresia were severe thrombocytopenia (AOR = 2.81(1.07-7.34)), timing of surgery (AOR = 3.7(1.34-10.1), aspiration pneumonia (AOR = 2.93(1.17-7.38)) and related abnormalities (AOR = 2.26(1.06-4.82)). CONCLUSION The results of this study showed that, when compared to other studies, a substantial percentage of newborn children with esophageal atresia had poor surgical outcomes. Early surgical management, aspiration pneumonia and thrombocytopenia prevention and therapy play a big part in improving the surgical prognosis for newborns with esophageal atresia.
Collapse
Affiliation(s)
- Natnael Moges
- Department of Paediatrics and Child Health Nursing, Debretabor University, College of Health Science, Debre Tabor, Ethiopia
| | - Kassaye Ahmed
- Department of Neonatal Nursing, University of Gondar, College of Health Science, Gondar, Ethiopia
| | - Dires Birhanu
- Department of Paediatrics and Child Health Nursing, Dilla University, College of Health Science, Dilla, Ethiopia
| | - Fekadesellasie Belege
- Department of Paediatrics and Child Health Nursing, Wollo University, College of Health Science, School of Nursing and Midwifery, Dessie, Ethiopia
| | - Asrat Dimtse
- Department of Neonatology, Addis Ababa University, College of Health Science, School of Medicine, Addis Ababa, Ethiopia
| | - Gashaw Kerebeh
- Department of Paediatrics and Child Health Nursing, Debretabor University, College of Health Science, Debre Tabor, Ethiopia
| | - Belayneh Dessie Kassa
- Debretabor University, College of Health Science, School of medicine, DebreTabor, Ethiopia
| | - Kumlachew Geta
- Department of Aesthesia, Debretabor University, College of Health Science, Debretabor, Ethiopia
| | - Keder Essa Oumer
- Department of Aesthesia, Debretabor University, College of Health Science, Debretabor, Ethiopia
| | - Edgeit Abebe Zewde
- Department of Biomedical Science, Debretabor University, College of Health Science, Debretabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, Debretabor University, College of Health Science, Debretabor, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, Debretabor University, College of Health Science, Debretabor, Ethiopia
| | - Solomon Demis
- Department of Paediatrics and Child Health Nursing, Debretabor University, College of Health Science, Debre Tabor, Ethiopia
| | - Fisha Alebel GebreEyesus
- Department of Department of Paediatrics and Child Health Nursing, Wolkite University, College of Medicine and Health Sciences, Wolkite, Ethiopia
| | - Berihun Bantie
- Department of Adult Health Nursing, Debretabor University, College of Health Science, Debretabor, Ethiopia
| |
Collapse
|
2
|
The Phenotypical Profile and Outcomes of Neonates with Congenital Tracheoesophageal Fistula Associated with Congenital Cardiac Anomalies Presenting for Surgery. CHILDREN 2022; 9:children9060887. [PMID: 35740824 PMCID: PMC9221898 DOI: 10.3390/children9060887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022]
Abstract
(1) Background: Neonates born with oesophageal atresia and/or tracheooesophageal fistula (OA/TOF) are usually born with a multitude of other congenital anomalies, which may affect their anaesthetic care and survival to hospital discharge. We reviewed the profile and outcome of neonates with OA/TOF and associated congenital cardiac anomalies presenting for surgery at an academic hospital in South Africa. (2) Methods: A retrospective, cross-sectional analysis of all medical records of neonates who had undergone surgical repair of OA/TOF was conducted at an academic hospital between January 2015 and December 2019. Descriptive statistics were used to report the data. Comparisons in perioperative events and outcomes between those with cardiac lesions and those without were done. (3) Results: Neonates presenting for OA/TOF repair with congenital cardiac defects had an incidence of 62 [95% CI 38.5–99.8] per 1000 days since birth. In total, 45.9% had associated cardiac anomalies, with PDA and ASD as the most prevalent lesions. There were statistically significant differences in intraoperative adverse events seen in neonates with congenital cardiac lesions as compared to those without. (4) Conclusion: Despite advances in neonatal critical care and anaesthetic and surgical techniques, OA/TOF associated with congenital cardiac anomalies is still associated with high mortality rates in developing countries.
Collapse
|
3
|
Masuya R, Muto M, Sugita K, Murakami M, Yano K, Harumatsu T, Onishi S, Yamada K, Yamada W, Matsukubo M, Kawano T, Machigashira S, Nakame K, Torikai M, Mukai M, Kaji T, Ieiri S. Physical growth and social prognosis of esophageal atresia after 15 years of age. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The mortality rate of esophageal atresia (EA) has significantly improved, but late complications remain problematic. We evaluated the physical growth, late complications, and social prognosis of postoperative patients with EA who have reached 15 years of age.
Methods
EA patients who were treated at our institution from 1984 to 2003 were enrolled. The follow-up, physical growth at the last visit, late complications and treatment, academic status, and employment situation were evaluated.
Results
Twenty-nine EA patients were registered, and the 23 surviving patients (79.3%) were followed. Anthropometry at the latest visit tended to be below the standard values. Fundoplication was performed in 6 (26.1%) of 9 (39.1%) patients with gastroesophageal reflux. Anastomotic stenosis was found in 12 patients (52.2%), and 2 (8.7%) were treated with re-anastomosis. Thirteen patients were attending a regular school, and one was attending a school for disabled children. Four had jobs from 18 years of age. Follow-up was aborted during early childhood in nine patients.
Conclusions
The physical size of EA was smaller than in the healthy population of the same age. Late complications had not affected the physical growth but were sometimes recognized in adolescence. The social prognosis of the patients was largely favorable.
Collapse
|
4
|
Siyotula T, Arnold M. An analysis of neonatal mortality following gastro-intestinal and/or abdominal surgery in a tertiary hospital in South Africa. Pediatr Surg Int 2022; 38:721-729. [PMID: 35235014 DOI: 10.1007/s00383-022-05100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Thirty-day, 6-month and 12-month post-operative mortality and assessment of factors associated with 30 day post-operative mortality were ascertained. METHOD A retrospective medical record audit for neonates who underwent gastrointestinal or abdominal wall surgery within the neonatal period at a tertiary free standing paediatric hospital during the 12-year period from 1 January 2007 to 31 December 2018. RESULTS The 30-day post-operative mortality rate was 83/762 (11%). Mortality resulted from: sepsis (74%), palliation due to ultra-short bowel length (12%), ventilation-associated pneumonia (10%), associated congenital cardiac lesions (3%) and intestinal failure-associated liver disease (1%). Surgery for necrotizing enterocolitis had the greatest 30-day post-operative mortality (28%). Most neonates (69%) who died were prematurely born. Mean age at surgery was ten days and mean age at death was six days. Abdominal compartment syndrome was noted post operatively in 15% patients. Risk factors for sepsis included central line-associated bloodstream infections (65%), respiratory tract infections (41%) and surgical complications [anastomotic breakdown (7%) and wound infection (24%)]. Mortality in patients from referral hospitals more than an hour's drive away was high (15/39, 38%). CONCLUSION Mortality is double that of high-income countries, although significantly lower than most African settings. Strategic quality-improvement interventions are required to optimize outcomes.
Collapse
Affiliation(s)
- Thozama Siyotula
- Division of Paediatric Surgery at Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Rd, Rondebosch, Cape Town, 7700, South Africa.
| | - Marion Arnold
- Division of Paediatric Surgery at Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Rd, Rondebosch, Cape Town, 7700, South Africa
| |
Collapse
|
5
|
Narsat MA, Kılıç ŞS, Özden Ö, Alkan M, Tuncer R, İskit HS. Can 18-years of data from a tertiary referral center help to identify risk factors in esophageal atresia? Pediatr Int 2022; 64:e15190. [PMID: 35522674 DOI: 10.1111/ped.15190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/03/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Esophageal atresia is a complex esophageal malformation with an incidence of 1 in 3,500-4,000 live births, and it usually occurs together with anomalies in other systems or chromosomes. This study aimed to investigate the short-term and long-term results of cases of esophageal atresia retrospectively in our institution and to analyze the factors affecting the outcome. METHODS Charts of the patients managed for esophageal atresia in our tertiary pediatric surgery department were investigated retrospectively. Statistical analysis was performed to determine the risk factors for morbidity and mortality. RESULTS One hundred and thirteen (95.8%) of 118 cases underwent a single-stage or staged esophagoesophagostomy procedure. In only five of the 40 patients with a long gap between the two atretic ends was an esophageal replacement procedure required. The most common early and late complications were anastomotic stenosis (41.6%) and gastroesophageal reflux (44.9%). In logistic regression analysis, the birthweight (OR [95% CI] = 0.998 [0.997, 0.999], P = 0.001) and preoperative inotrope requirement (OR [95% CI] = 13.8 [3.6-53.3], P < 0.001) were the two risk factors in the mortality prediction model obtained by multivariate analysis. The gap length between the two atretic ends (OR [95% CI] = 1.436 [1.010, 2.041], P = 0.044) and the number of sutures for anastomosis (OR [95% CI] = 1.313 [1.042, 1.656], P = 0.021) were the two risk factors in the gastroesophageal reflux prediction model obtained by multivariate analysis. CONCLUSIONS Our study's early and late complication rates were like those found in other studies. Identifying risk factors would be beneficial and might help reduce the severity of potential complications in esophageal atresia patients. Prospective studies on large patient series would help develop registry-based, standardized management protocols.
Collapse
Affiliation(s)
- Mehmet Ali Narsat
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey.,Department of Pediatric Surgery, Kastamonu Training And Research Hospital, Kastamonu, Turkey
| | - Şeref Selçuk Kılıç
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Önder Özden
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Murat Alkan
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Recep Tuncer
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Hilmi Serdar İskit
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| |
Collapse
|
6
|
Abstract
PURPOSE Tracheoesophageal fistula (TEF) is a bellwether for a country's ability to care for sick newborns. We aim to review the existing literature from low- and middle-income countries in regard to management of those newborns and the possible approaches to improve their outcomes. METHODS A review of the existing English literature was conducted with the aim of assessing challenges faced by providers in LMIC in terms of diagnostic, preoperative, operative and post-operative care for TEF patients. We also review the limited literature for performing thoracoscopic repair in the developing world context and suggest methods for introduction of advanced thoracoscopic procedures including techniques for providing anesthesia to these challenging babies. RESULTS While outcomes related to technique from LMIC are comparable to the developed world, rates of secondary complications like sepsis and pneumonia are higher. In many areas, repairs are conducted in a staged fashion with minimal utilization of thoracoscopic approach. The paucity of resources creates strain on intraoperative and post-operative management. CONCLUSION Clearly, not all developing world contexts are ready to attempt thoracoscopic repair but we outline suggestions for assessing the existing capabilities and a stepwise gradual implementation of advanced thoracoscopy when appropriate.
Collapse
|
7
|
Ekenze SO, Ajuzieogu OV, Nwankwo EP. Effect of cardia banding and improved anaesthetic care on outcome of oesophageal atresia in a developing country. J Trop Pediatr 2018; 64:539-543. [PMID: 29253256 DOI: 10.1093/tropej/fmx097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We comparatively analysed cases of oesophageal atresia (OA) managed in Enugu, south-eastern Nigeria from October 2010 to September 2015 to evaluate our short-term outcome with management following incorporation of temporary cardia banding to gastrostomy for late presenting cases and improved anaesthesia in 2013. Overall, 19 cases were analysed. The clinical parameters did not differ in the cases managed before (Group A) and after (Group B) these introductions. Four (21.1%) cases had primary repair (2 per group), six (31.6%) had delayed primary repair after treatment of pneumonitis (Group A 5; Group B 1) and nine (47.3%) had delayed primary repair after gastrostomy (Group A 4; Group B 5). Anaesthesia-related mortality dropped from 53.8 to 7.7% and survival improved from 9.1 to 62.5% following the introductions. Despite persisting barriers to care, outcome of OA in our setting may improve with better anaesthesia and incorporation of temporary cardia banding to gastrostomy.
Collapse
Affiliation(s)
- Sebastian O Ekenze
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna V Ajuzieogu
- Department of Anaesthesia, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Elochukwu P Nwankwo
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| |
Collapse
|
8
|
Predictive factors affecting the prognosis and late complications of 73 consecutive cases of esophageal atresia at 2 centers. Pediatr Surg Int 2018; 34:1027-1033. [PMID: 30084025 DOI: 10.1007/s00383-018-4326-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE While the diagnosis and outcomes of esophageal atresia (EA) have improved, associated anomalies, the management of late complications and growth remain major issues. We analyzed factors that affected the prognosis, late complications and growth. METHODS We retrospectively reviewed EA patients treated at two centers from 1984 to 2016. Patient characteristics, complications (gastroesophageal reflux [GER], anastomotic stenosis, tracheomalacia, dysphagia) and growth were evaluated. RESULTS Seventy-three EA patients were treated (overall survival rate:80.8%). The mean birth weight was 2514 ± 509 g in the surviving group, and 2453 ± 567 g in the fatal group excluded chromosomal abnormality (p = 0.76). Cardiac and chromosomal anomalies significantly affected mortality. Postoperative GER and anastomotic stenosis each occurred in 39% of the patients. Only GER was significantly affected by the Gross classification. The standard deviation (SD) values of the EA patients' growth were all lower than in the normal population. The SD of body weight was significantly lower in patients with extremity anomalies. CONCLUSIONS Associated cardiac and chromosomal anomalies significantly affected the prognosis. GER and anastomotic stenosis were the most common late complications. The growth of the surviving cases was insufficient. These factors will help optimize the therapeutic strategies and postoperative management for EA.
Collapse
|
9
|
Ekenze SO, Modekwe VO, Ajuzieogu OV, Asinobi IO, Sanusi J. Neonatal surgery in a developing country: Outcome of co-ordinated interdisciplinary collaboration. J Paediatr Child Health 2017; 53:976-980. [PMID: 28600851 DOI: 10.1111/jpc.13610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/17/2017] [Accepted: 04/08/2017] [Indexed: 11/29/2022]
Abstract
AIM Neonatal surgery in low-income and middle-income countries has a poorer outcome when compared with high-income countries. This study evaluated the management challenges and outcomes of neonatal surgery before and after the introduction of focused interdisciplinary team management in 2013. METHODS We retrospectively analysed neonatal surgery undertaken at two referral hospitals in Enugu, south-eastern Nigeria from January 2011 to November 2015. Cases managed prior to July 2013 (group A) were compared with those managed from July 2013 (group B). RESULTS There were 91 cases (group A, 47; group B, 44). The common neonatal conditions were oesophageal atresia (21), anorectal malformation (18) and intestinal atresia (18). The surgical conditions, birthweight, age at presentation and associated anomalies did not differ in the two groups. The treatment was also similar except in oesophageal atresia, where cardiac banding was added to the temporary gastrostomy in late presenting cases with undernutrition in group B. Postoperative complications occurred in 43 (47.3%) cases (group A, 55.3%; group B, 38.6%; P > 0.05), and the overall mortality was 33 (35.3%: group A, 48.9%; group B, 22.7%: P < 0.05). Causes of mortality were unremitting sepsis (group A, 11; group B, 5), anaesthesia complications (group A, 5; group B, 0) and respiratory complication (group A, 7; group B, 5). Delayed presentation, inadequate facilities and defective health insurance scheme were challenges in the two groups. CONCLUSION Despite the persisting challenges, co-ordinated team management may result in the modest improvement of outcomes of neonatal surgery in our setting. Addressing these challenges may further improve outcomes.
Collapse
Affiliation(s)
- Sebastian O Ekenze
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Victor O Modekwe
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Obinna V Ajuzieogu
- Department of Anaesthesia, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Isaac O Asinobi
- Neonatology Unit, Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Jubril Sanusi
- Nursing Services Division, University of Nigeria Teaching Hospital, Enugu, Nigeria
| |
Collapse
|
10
|
Li XW, Jiang YJ, Wang XQ, Yu JL, Li LQ. A scoring system to predict mortality in infants with esophageal atresia: A case-control study. Medicine (Baltimore) 2017; 96:e7755. [PMID: 28796065 PMCID: PMC5556231 DOI: 10.1097/md.0000000000007755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Esophageal atresia (EA) is a rare anomaly that mandates surgical intervention. Patients with EA often have complicated medical courses due to both esophageal anomalies and related comorbidities. Although several prognostic classification systems have been developed to decrease the mortality rate in EA, most systems focus only on the influence of the major anomaly, and external risk factors that could be influenced by the neonatal caregivers to a certain extent are not included. The aim of this study was to investigate the risk factors for in-hospital mortality in neonates with EA and develop a scoring model to predict mortality.In total, 198 infants with EA who were treated with surgical intervention at the Children's Hospital of Chongqing Medical University between March 2004 and June 2016 were included. The demographic information, clinical manifestations, laboratory testing, and outcomes during hospitalization were analyzed retrospectively. A predictive scoring model was developed according to the regression coefficients of the risk factors.The mortality rate was 18.1% (36/198). In the univariate analysis, higher incidences of prematurity, low birth weight, long gap, anastomotic leak, respiratory failure, postoperative sepsis, respiratory distress syndrome, pneumothorax, and septic shock were found in the nonsurvivor group than in the survivor group (P < .05). In the logistic regression analysis, anastomotic leak (OR: 10.75, 95% CI: 3.113-37.128), respiratory failure (OR: 4.104, 95% CI: 2.292-7.355), postoperative sepsis (OR: 3.564, 95% CI: 1.516-8.375), and low birth weight (OR: 8.379, 95% CI: 3.357-20.917) were associated with a high mortality rate. A scoring model for predicting death was developed with a sensitivity of 0.861, a specificity of 0.827, a positive predictive value of 0.524, and a negative predictive value of 0.963 at a cutoff of 2 points. The area under the receiver-operating characteristic curve of the score was 0.905 (95% CI, 0.863-0.948, P = .000) for death from EA. The mortality rate increased rapidly as the scores increased, and all patients with scores ≥5 died.Anastomotic leak, respiratory failure, postoperative sepsis, and low birth weight are independent risk factors for mortality in EA. Infants with a predictive score of 5 had a high risk of death.
Collapse
|
11
|
Ekenze SO, Ajuzieogu OV, Nwomeh BC. Challenges of management and outcome of neonatal surgery in Africa: a systematic review. Pediatr Surg Int 2016; 32:291-9. [PMID: 26783085 DOI: 10.1007/s00383-016-3861-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Disparity still exists in the outcome of neonatal surgery between high-income countries and low-income and middle-income countries. This study reviews publications on neonatal surgery in Africa over 20 years with a focus on challenges of management, trends in outcome, and potential interventions to improve outcome. METHODS We did a literature review by searching PubMed and African Index Medicus for original articles published in any language between January 1995 and September 2014. A data extraction sheet was used to collect information, including type of study, demographics, number of cases, outcome, challenges, and suggestions to improve outcome. RESULTS A total of 51 studies from 11 countries met the inclusion criteria. The 16 studies in the first 10 years (1995-2004; group A) were compared with the 35 in the last 10 years (2005-2014; group B). Nigeria (n = 32; 62.7 %), South Africa (n = 7; 13.7 %), Tanzania (n = 2; 3.9 %), and Tunisia (n = 2; 3.9 %) were the predominant sources of the publications, which were retrospective in 38 (74.5 %) studies and prospective in 13 (25.5 %) studies. The mean sample size of the studies was 95.1 (range 5-640). Overall, 4849 neonates were studied, with median age of 6 days (range 1-30 days). Common neonatal conditions reported were intestinal atresia in 28 (54.9 %) studies, abdominal wall defects in 27 (52.9 %), anorectal malformations 25 in (49.0 %), and Hirschsprung's disease, necrotising enterocolitis, and volvulus neonatorum in 23 (45.1 %) each. Mortality was lowest (<3 %) in spina bifida and facial cleft procedures, and highest (>50 %) in emergency neonatal surgeries involving bowel perforation, bowel resection, congenital diaphragmatic hernia, oesophageal atresia, and ruptured omphalocele or gastroschisis. Overall average mortality rate was higher in group A than group B (36.9 vs 29.1 %; p < 0.001), and varied between the groups for some conditions. The major documented challenges were delayed presentation and inadequate facilities in 39 (76.5 %) studies, dearth of trained support personnel in 32 (62.7 %), and absence of neonatal intensive care in 29 (56.9 %). The challenges varied from country to country but did not differ in the two groups. CONCLUSION Improvement has been achieved in outcomes of neonatal surgery in Africa in the past two decades, although several of the studies reviewed are retrospective and poorly designed. Cost effective adaptations for neonatal intensive care, improved health-care funding, coordinated neonatal surgical care via regional centres, and collaboration with international partners are potential interventions that could help to address the challenges and further improve outcome.
Collapse
Affiliation(s)
- Sebastian O Ekenze
- Sub-Department of Pediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, 400001, Enugu, Nigeria.
| | - Obinna V Ajuzieogu
- Department of Anesthesia, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | |
Collapse
|
12
|
Zhu H, Shen C, Xiao X, Dong K, Zheng S. Reoperation for anastomotic complications of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50:2012-5. [PMID: 26388130 DOI: 10.1016/j.jpedsurg.2015.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/24/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND/PURPOSE The purpose of the study was to review our experience in the re-operative management of anastomotic complications (ACs) following primary repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) and to assess the outcomes after reoperation. METHODS We retrospectively reviewed 21 EA patients who underwent reoperation from 2005 to 2014. Clinical features, reasons for reoperation, diagnosis of ACs, re-operative procedures and outcomes, as well as long-term follow-up of reoperation were analyzed. RESULTS Reoperation occurred in 16 recurrent TEF (RTEF) cases (76.2%), 4 severe anastomotic strictures (AS), and 1 anastomotic leakage (AL) cases (19% and 4.8%, respectively). All of AS and AL were confirmed by esophagography. RTEF were confirmed by esophagoscopy and bronchoscopy. All of the cases underwent reoperation successfully. The average operative time and length of post-operative hospital stay were 2.7 ± 0.8 hours and 15.4 ± 3.3 days, respectively. The mortality rate was 4.8%. All of the cases were followed up from 1 to 107 months after reoperation. No patients experienced respiratory or feeding issues. No severe postoperative complications were shown in all re-operative cases. CONCLUSIONS ACs including severe AS and AL as well as RTEF are the significant indications for reoperation after EA repair. The reoperation was effective to treat multiple anastomotic complications.
Collapse
Affiliation(s)
- Haitao Zhu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Chun Shen
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Xianmin Xiao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China.
| |
Collapse
|