African Journal of Paediatric Surgery

ORIGINAL ARTICLE
Year
: 2009  |  Volume : 6  |  Issue : 2  |  Page : 98--101

Neonatal intestinal obstruction in Benin, Nigeria


Osarumwense David Osifo, Jonathan Chukwunalu Okolo 
 Department of Surgery, Paedatric Surgery Unit, University of Benin Teaching Hospital, Benin City, Nigeria

Correspondence Address:
Osarumwense David Osifo
Department of Surgery, Paedatric Surgery Unit, University of Benin Teaching Hospital, Benin City
Nigeria

Abstract

Background: Intestinal obstruction is a life threatening condition in the newborn, with attendant high mortality rate especially in underserved subregion. This study reports the aetiology, presentation, and outcome of intestinal obstruction management in neonates. Materials and Methods: A prospective study of neonatal intestinal obstruction at the University of Benin Teaching Hospital, Benin, Nigeria, between January 2006-June 2008. Data were collated on a structured proforma and analysed for age, sex, weight, presentation, type/date of gestation/delivery, aetiology, clinical presentation, associated anomaly, treatment, and outcome. Results: There were 71 neonates, 52 were males and 19 were females (2.7:1). Their age range was between 12 hours and 28 days (mean, 7.9 ± 2.7 days) and they weighed between 1.8 and 5.2 kg (average, 3.2 kg). The causes of intestinal obstruction were: Anorectal anomaly, 28 (39.4%); Hirschsprung«SQ»s disease, 8 (11.3%)«SQ» prematurity, 3 (4.2%); meconeum plug, 2 (2.8%); malrotation, 6 (8.5%); intestinal atresia, 8 (11.3%); necrotising enterocolitis (NEC), 4 (5.6%); obstructed hernia, 4 (5.6%); and spontaneous gut perforation, 3 (4.2%). Also, 27 (38%) children had colostomy, 24 (33.8%) had laparotomy, 9 (12.8%) had anoplasty, while 11 (15.4%) were managed nonoperatively. A total of 41 (57.7%) neonates required incubator, 26 (36.6%) needed total parenteral nutrition, while 15 (21.1%) require d paediatric ventilator. Financial constraint, late presentation, presence of multiple anomalies, aspiration, sepsis, gut perforation, and bowel gangrene were the main contributors to death. Neonates with lower obstructions had a better outcome compared to those having upper intestinal obstruction ( P < 0.0001). Conclusion: Outcomes of intestinal obstruction are still poor in our setting; late presentation, financial constraints, poor parental motivation and lack of basic facilities were the major determinants of mortality.



How to cite this article:
Osifo OD, Okolo JC. Neonatal intestinal obstruction in Benin, Nigeria.Afr J Paediatr Surg 2009;6:98-101


How to cite this URL:
Osifo OD, Okolo JC. Neonatal intestinal obstruction in Benin, Nigeria. Afr J Paediatr Surg [serial online] 2009 [cited 2019 Jun 25 ];6:98-101
Available from: http://www.afrjpaedsurg.org/text.asp?2009/6/2/98/54772


Full Text

 Introduction



Intestinal obstruction in neonates is common and unlike in the adults or older children, the majority are due to congenital causes. [1],[2] The attendant pathological sequalae, which progresses rapidly to irreversible complications, is poorly tolerated by the newborns. Early presentation, prompt diagnosis, and appropriate treatment have improved outcome in many developed countries. [2],[3] However, in many of our subregion centers, late presentation of clinically compromised neonates is rampant. This is compounded by the lack of basic facilities for the proper surgical management of neonates, poor socioeconomic status of many parents, and the cultural beliefs and poor attitudes towards neonates born with surgical pathology. [4],[5]

Emergency operation and anaesthesia for neonates in poor clinical states, pose major challenges in sub- Saharan Africa. [4],[6] Moreover, associated multiple anomalies, particularly intracardiac anomalies, are rarely diagnosed preoperatively, resulting in many unexplained anaesthetic complications and mortality. [2],[6],[7]

The aetiology of neonatal intestinal obstruction, its presentation, attendant morbidity, and outcome of the treatment vary significantly between centres. [2],[8],[9],[10],[11] In this prospective study, we present our experience with neonatal intestinal obstruction at the University of Benin Teaching Hospital.

 Materials and Methods



This was a prospective study of neonates with intestinal obstruction at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, between January 2006 and June 2008. UBTH is a referral hospital for neighbouring states. Consecutive cases of neonates who were presented with intestinal obstruction were recruited, after obtaining approval from the hospital's Ethical Approval Committee Board.

The age at presentation, sex, weight, type of delivery (vaginal/caesarean), date at delivery (pre/full-term), type of gestation (multiple/single), aetiology, presence of associated congenital anomaly, treatment, morbidity, outcome, and follow-up were documented on a structured proforma. During the period, three babies who were discharged against medical advice due to financial constraints were excluded from the study. The data were analysed using SPSS version 11 (SPSS, Chicago, 111). Continuous data were expressed as mean ± SD, while categorical data were analysed using Chi-square test with P values P P [12] The outcome of upper gastrointestinal obstruction was generally poorer than those of lower obstruction in this study. [2],[13],[14],[15] This may be attributed to vomiting with attendant risk of aspiration, sepsis, and rapid onset of fluid/electrolytes derangement compared to lower obstructions in which these set in late, and in a much milder degree.

As in other studies in this subregion, [4],[5],[6],[7] the mode, type and place of delivery did not adversely influence the outcome of neonates with intestinal obstruction. Although, babies delivered by rural women presented much later than those who were delivered within the hospital, the difference in overall survival rate was not significant. [5]

Late presentation compounded by lack of facilities, financial constraints, and poor parents' motivation, were the major challenges in this study as in other African settings. [3],[4] Although, many neonates presented within the first week of life, the delay was significant when compared to the developed countries, where very early presentation and adequate intervention is the rule. [2],[9],[16],[17]

Aspiration during vomiting, splinting of the diaphragma by abdominal distension (which impedes breathing), and the high propensity to sepsis are the factors which impact negatively to the outcome of neonatal intestinal obstruction. [2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[18]

Intestinal perforation and/or gangrene with resultant peritonitis were associated with severe preoperative morbidity and postoperative complications such as wound infection, endotoxic shock, burst abdomen, nutritional problems, and a high mortality rates. These groups of patients required mandatory emergency life saving operations; unfortunately in this study, in an environment which lacks facilities needed to operate and handle postoperative problems of such neonates resulting in a high mortality rate. [1],[4],[5],[6],[7],[12],[18],[19],[20],[21],[22] The presence of associated congenital anomalies is reported to increase mortality rates in neonatal intestinal obstruction. [1],[23] We experienced a similar trend in the present study; the majority of the associated anomalies occurred in anorectal malformations, confirming previous reports. [24],[25]

In conclusion, the aetiology, mode of presentation, morbidity, and outcome of treatment of intestinal obstruction in neonates in this study were not significantly different from other reports in the subregion. Neonates with multiple anomalies, upper intestinal obstruction, and in whom intestinal obstruction were complicated by severe abdominal distension, aspiration, sepsis, gut perforation and bowel gangrene had poorer outcome. Late presentation, financial constraint, lack of basic facilities, and poor parental motivation were the major determinants of management outcome of neonatal intestinal obstruction in this subregion.

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