CAUSES AND SURGICAL OUTCOMES OF NEONATAL INTESTINAL OBSTRUCTION AT A KENYAN TERTIARY HOSPITAL

Abstract

Background: Neonatal intestinal obstruction (NIO) is a major indication for
admissions globally with high morbidity and mortality rates. Availability of
adequate and contextual data about the causes and surgical outcomes of NIO could inform prevention and management modalities.
Objective: To determine aetiology and surgical outcomes among neonates with intestinal obstruction at Moi Teaching and Referral Hospital (MTRH), Eldoret,Kenya.
Methods: A hospital-based observational prospective study conducted among sixty-three (63) neonates with NIO who had undergone surgery at MTRH between 10th August 2022 and 9th August 2023. After obtaining parental consent, neonatal clinical characteristics and maternal antenatal profile data were collected. The neonates were then followed for a maximum of seven days postsurgery to determine surgical management and outcomes. A test of associations was conducted between independent variables (etiology and clinical presentation) and surgical outcomes using Fisher exact tests (critical value of ≤0.05) with odds computed at a 95% confidence interval.
Results: The mean neonatal age at presentation was 9.75 ± 6.75 days. Forty-one (65.1%) were male, and 84.1% had congenital anomalies. The overall mean birthweight and gestation age were 2,670 ± 597.25 grams and 37.19 ± 2.53 weeks, respectively. The most common NIO aetiology was anorectal malformation (22.3%; n=16) followed by malrotation (18.4%; n=13). Bowel resection and anastomosis (32.9%; n=24) were the most common type of surgical management offered, followed by colostomy (19.2%; n=14). Mortality was reported among 27% of all neonates enrolled. Prolonged hospitalization was the leading (73%; n=46) secondary surgical outcome with a mean duration of 21.98 ±12.96 days, followed by neonatal sepsis (33.3%; n=21). Elevated platelet count (p=0.016) and C-Reactive Protein (p=0.021) at admission were significantly associated with
post-surgical mortality.
Conclusion: The most common cause of NIO was anorectal malformation. About three-quarters of the neonates who underwent surgery survived. Post-surgical elevated platelet counts and C-reactive protein values significantly predicted the likelihood of mortality.