Factors affecting the management and outcome of neonatal surgery in Benin City, Nigeria.

INTRODUCTION: Neonatal surgery poses a major challenge, particularly in developing countries. The objective of this study was to determine the pattern and various factors that may affect the outcome of surgical management of neonates in a developing country like Nigeria.
METHODS: A retrospective study was carried out of all neonates who underwent surgery over an 8-year period at the University of Benin Teaching Hospital, Benin City, Nigeria.
RESULTS: There were 83 males and 35 females with a male/female ratio of 3.4:1. The age of the patients was from 12 hours to 28 days (mean 8+/-5.1 days) and they weighed from 1.8 to 3.9 kg (mean 2.7+/-0.5 kg) on presentation. A large proportion of the babies, 103 (87.3%), were delivered by poor women living in rural areas without supervised antenatal care and delivery. Mortality did not differ significantly between those babies delivered in hospital and those delivered at home (p=0.2127). However, unhygienic care of neonates, which allowed overwhelming resistant sepsis to set in, the delay in presentation and hazardous transportation without stabilisation led to high morbidity and mortality rates. The difference in mortality was significant when the mortality of patients operated on an emergency basis was compared with those operated electively (p=0.0483). Nine (75%) patients with tracheo-oesophageal pathologies, 24 (35%) patients with gastrointestinal anomalies, 1 (17%) with a cranio-spinal defect, 1 (13%) with a head/neck defect and 1 (5%) with a genitourinary anomaly died, with no death in the musculoskeletal group. Overall, a total of 56 (47.4%) morbidities and 36 (30.5%) mortalities were recorded.
CONCLUSION: The morbidity and mortality following surgical management of neonates is still very high in this hospital. Financial constraints, emergency surgery, delivery outside the hospital and tracheo-oesophageal/gastrointestinal anomalies were significant and contributory factors.