Neonatal Surgical Emergencies at Moi Teaching and Referral Hospital in Eldoret -Kenya.

Abstract

Background: Success in the management of neonatal surgical emergencies depends on prompt diagnosis, adequate resuscitation, good nursing care, safe anaesthesia and competent surgery. Considering that centres for paediatric surgery are few in the developing world, an added requirement is application of the principles of neonatal transport, when neonates are transported to these centres from wherever they are born. These are the challenges that Moi Teaching & Referral Hospital (MTRH) faces in the provision of emergency service to neonates. The hospital serves the Western Kenya region with a population of about 15 million. This study was aimed at determining the pattern and the outcome of neonatal emergency surgery at MTRH. Methods: This was a retrospective descriptive study done at The Moi Teaching & Referral Hospital, Eldoret-Kenya. The study population included all neonates with emergencies managed by the paediatric surgical service between July 2003 and July 2006. Data was obtained from the theatre register and patients’ files. Results: Sixty nine neonates were operated between July 2003 and July 2006 but only 56 files were completed for analysis. Of the 56 neonates, 35 were male and 21 female (M: F ratio of 1.7:1). The median age of presentation was 3 days with a range of 1 – 22 days. Referrals represented 32 (60%). The leading three diagnoses were anorectal malformation 19 (34%) intestinal atresia 8 (14%) and anterior abdominal wall defects 7 (13%). 14 (25%) of the neonates had low birth weight. Application of principles of neonatal transport was poor. Inadequacy of fluid therapy was noted in 26 (45%) of the neonates. Challenges of providing parental nutrition were encountered in 11 (20%). Sepsis was the leading complication and major cause of mortality. Overall mortality was 18 (24%) but was 14 (44%) among the referrals. Conclusion: Morbidity and mortality was high in the management of neonates with surgical emergencies. Reversing the trend will require: early referral and presentation; overcoming the challenges of providing infrastructure that will enable good nursing care, and improving neonatal transport in the region.