[Epidemiology of neonatal surgical emergencies in Ouagadougou]

Congenital malformations of the gastrointestinal tract in neonates at aristide le dantec university hospital in Dakar: Concerning 126 cases

OBJECTIVE

Congenital malformations of the gastrointestinal tract are one of the major causes of neonatal mortality, especially in developing countries. The aim of this study is to assess the overall management of gastrointestinal malformations.

PATIENTS AND METHODS

The study design is monocentric and retrospective. It includes all newborns aged 1-28 days with malformations of the gastrointestinal tract between 1^st January 2014 and 31^st December2018, at the Paediatric Surgery Department of Aristide Le Dantec University Hospital in Dakar. Data were collected by studying patient's records and surgical procedures.

RESULTS

During the five-year study, 405 newborns with congenital anomalies were admitted to our hospital. A total of 126 newborns were diagnosed with gastrointestinal tract malformations. The incidence was 25.2 cases a year. The sex distribution was 74 boys (58.7%) and 52 girls (41.2%). The mean age at diagnosis was 7.4 ± 3.2 days. Two cases were diagnosed antenatal (1.59%). The mean time to post-natal diagnosis was 6.5 ± 2.1 days. The most common malformation was oesophageal atresia with 43 cases (34.1%). The average time between diagnosis and surgery was 48 h. Out of the 126 cases, 77 (61.1%) received surgery and 49 (38.9%) died before surgery. The main causes of pre-operative death were intricate and dominated by lung infections (42.9%). Among the 77 newborns, who received surgery, 38 (%) had a simple post-operative course, 39 (50.6 %) died. Post-operative deaths were dominated by anaesthetic complications (30.8%), lung infections (46.1%). The overall mortality was 69.8% (n = 88).

CONCLUSION

The low socio-economic status, poor pre-natal diagnosis, prematurity, post-natal diagnostic delay, obsolete medical equipment and the lack of neonatal intensive care units were identified as the major factors for high mortality in neonates with gastrointestinal tract malformations in a developing country.

Acute mechanical intestinal obstruction in children at zinder national hospital, Niger: Aetiologies and prognosis

BACKGROUND

To describe the aetiological and prognostic aspects of acute mechanical intestinal obstruction (AMIO) in children at Zinder National Hospital (Niger).

MATERIALS AND METHODS

This was a cross-sectional study on a period to January 2013-June 2015. The database included all children under 15 years of age with a surgical diagnosis of mechanical intestinal obstruction. P < 0.05 was considered statistically significant for analysis.

RESULTS

AMIOs represent 21.78% (n = 78) of child digestive surgical emergencies (n = 358). Median age was 12 months (range: 1 day-15 years). Fifteen (19.23%) were neonates and sixty children (76.92%) had ≤60 months. The sex ratio (male/female) was 2.8. The mean time from onset to presentation was 39.96 ± 36.22 h. Intussusception and strangulated hernias were the main causes of AMIO with, respectively, 43.59% (n = 34) and 29.48% (n = 23). Anorectal malformations represent 17.95% (n = 14) of cases of AMIO. Intestinal resection was made in 22.08% and colostomy in 19.23% of patients. The average length of hospital stay was 6.44 ± 4.30 days. The post-operative complications were recorded in 26 patients (33.33%), mostly surgical site infections. Overall mortality of AMIO was 15.38% (n = 12). It was higher in the neonates (33.33%) (P = 0.032). Deaths were associated with delay of admission (P = 0.0005) and waiting time for surgery (P = 0.019).

CONCLUSION

Intussusception and strangulated hernia are the most common cause of AMIO in children. Diagnostic and therapeutic delays, lack of paediatric intensive care and post-operative complications are prognostic factors.