We had prospectively audited outcome of two hundred and sixty one
surgical neonates admitted in our unit over a period of one year. One
hundred and forty two neonates (54%) presented within the first 48
hours. Babies with surface defects, which were obvious viz.,
Meningomyelocele invariably presented very early and other babies
presented late. Seventy five per cent babies were males and twenty five
per cent were females. Ninety per cent of the babies were brought from
outside Chandigarh and had to travel long distance on personal transport
or public transport. The distances had to be evaluated on the time taken
for transportation rather their Km distances. Most of them did not have
a pretranspo rtresuscitation or any care during transportation. Fifteen
per cent were preterm and sixty seven per cent weighed less than 2500 g.
Antenatal period was not supervised in 29% patients. Only 20% of the
supervised deliveries had antenatal ultrasound examination. Less than 3%
of the babies were referred prenatally with congenital abnormality. The
commonest causes of referral were bile stained vomitus, delayed passage
of meconium, respiratory distress, excessive oral secretions, difficulty
in feeding, delayed passage of urine or absent anal orifice.
The female gender babies were positively
discriminated against by the parents in assuring the quality of
treatment. The factors that favored survival were birth weight >2.5Kg (p
<0.05), absence of tachypnea (Respiration rate <50/m; p<0.05) and SpO2
>94% at admission. Against the requirement of 55 beds, 15 ventilators
and 108 nursing staff (as per international norms) we only had 6 ICU
beds, 3 ventilators and 26 nursing staff. In order to improve neonatal
surgical survival several of these key factors will have to be corrected
by the Government of India. Investment in neonatal surgery must be seen
as a one-time investment, which results in healthy baby with normal
longevity of life. Unless special attention is given by government of
India or by UNICEF, WHO and other funding agencies, neonatal surgical
mortality will continue to be high in developing countries. Investments
on proper antenatal care and antenatal diagnosis will be very effective
in improving surgical results.
Acknowledgement
The authors gratefully acknowledge Dr. Ram Samujh and
Mrs. Balpinder Kaur for their kind help in the data collection and
analysis.
K.L. Narasimhan,
Vijay Bhaskar,
Department of Pediatric Surgery,
Postgraduate Institute of Medical
Education and Research,
Chandigarh 160012,
India. Correspondence to:
Dr. K.L. Narasimhan,
Associate Professor,
Department of Pediatric Surgery,
P.G.I.M.E.R., Chandigarh 160 012, India.
E-mail:
[email protected]
