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Dr. Hadalgi L.S

Dr.Bidari’s Ashwini Children Hospital and Research Centre, India

Title: : Etiological spectrum of abdominal emergencies in newborns – a teritiary care experience

Biography

Biography: Dr. Hadalgi L.S

Abstract

INTRODUCTION:

Surgical emergencies in neonates are usually congenital malformations. Their smaller size, immature organ system and differing volume capacities, pose challenge during perioperative period.

AIMS AND OBJECTIVES

  1. To study the  incidence and etiology of acute abdomen in neonates.
  2. To Study the outcome of  above newborns.

MATERIALS AND METHODES

This is a 1 year prospective observational study.  Patient’s profile, symptoms,  etiology of acute abdomen, surgical intervention and their outcomes were analyzed.

RESULTS:

Total admissions to NICU were 1206. A total of 27 neonates(2.2%) were admitted with acute abdomen. 5 babies had underlying medical condition -3 had Septic ileus, 1 had meconium ileus, 1 had portal vein thrombosis . Out of all surgical cases(22),  majority were males 17(77%). 10 babies (45%)were born at term, 12 were preterms of gestational age 30-37wks. 6 babies were >2500 gms, 4 babies were LBW, 2 babies were VLBW.  9 babies(40%) presented with in 1st  week of life majority diagnosed to have ARM and intestinal obstruction. Mean age of  NEC presenting as acute abdomen was 2nd  week. Malrotation and colonic perforation presenting as intestinal obstruction were encountered in  3rd week. Most common clinical presentation was abdominal distension with bilious vomiting. 22 babies  required surgical correction. 7(32%) were diagnosed with Anorectal malformations, 2(9%) had hirschsprung disease, 6(27%) had stage III necrotizing enterocolitis ,5(23%) diagnosed with malrotation ,1(4.5%) for Gastroschisis and 1(4.5%) with Ruptured omphalocoele. 7 postop cases died, mortality being  32%,  mainly attributed to infection, multiple atretic gut.

DISCUSSION

Most common surgical conditions in the newborn involve gastrointestinal tract.  Most of our patients were male(77%). 40% of cases presented in first week of life, as ARM or intestinal obstruction, second most common cause being intestinal atresia. This pattern of etiology agrees with Deshmukh SN et al. Corrective surgeries done in most of our cases.  Overall mortality rate in our study was 32%,  nearing other studies. Highest mortality observed due to  NEC, septicaemia, multiple atretic gut. No mortality observed in Hirschsprungs disease,ARM.

CONCLUSION

Early presentation observed  in Anorectal malformations, intestinal atresias, meconium ileus.Hirschsprung and Malrotation presented later. Hence sick newborns borns with congenital malformations are salvageable if given proper NICU care,specialist surgeon and anaesthetist and ideal postoperative care.