AIM:Neonatal surgery in low-income and middle-income countries has a poorer outcome when compared with high-income countries. This study evaluated the management challenges and outcomes of neonatal surgery before and after the introduction of focused interdisciplinary team management in 2013. METHODS:We retrospectively analysed neonatal surgery undertaken at two referral hospitals in Enugu, south-eastern Nigeria from January 2011 to November 2015. Cases managed prior to July 2013 (group A) were compared with those managed from July 2013 (group B). RESULTS:There were 91 cases (group A, 47; group B, 44). The common neonatal conditions were oesophageal atresia (21), anorectal malformation (18) and intestinal atresia (18). The surgical conditions, birthweight, age at presentation and associated anomalies did not differ in the two groups. The treatment was also similar except in oesophageal atresia, where cardiac banding was added to the temporary gastrostomy in late presenting cases with undernutrition in group B. Postoperative complications occurred in 43 (47.3%) cases (group A, 55.3%; group B, 38.6%; P > 0.05), and the overall mortality was 33 (35.3%: group A, 48.9%; group B, 22.7%: P < 0.05). Causes of mortality were unremitting sepsis (group A, 11; group B, 5), anaesthesia complications (group A, 5; group B, 0) and respiratory complication (group A, 7; group B, 5). Delayed presentation, inadequate facilities and defective health insurance scheme were challenges in the two groups. CONCLUSION:Despite the persisting challenges, co-ordinated team management may result in the modest improvement of outcomes of neonatal surgery in our setting. Addressing these challenges may further improve outcomes.

译文

目的:与高收入国家相比,低收入和中等收入国家的新生儿外科手术效果较差。这项研究评估了2013年引入重点跨学科团队管理前后的新生儿手术管理挑战和结局。
方法:我们回顾性分析了2011年1月至2015年11月在尼日利亚东南部Enugu的两家转诊医院进行的新生儿手术。将2013年7月之前的病例(A组)与2013年7月之前的病例(B组)进行了比较。
结果:共91例(A组47例; B组44例)。新生儿常见的情况是食道闭锁(21),肛门直肠畸形(18)和肠道闭锁(18)。两组的手术条件,出生体重,就诊年龄和相关异常均无差异。除食管闭锁外,B组在营养不良的晚期病例中,在临时胃造口术中加上了心脏束带,治疗也相似。B组术后并发症发生了43例(47.3%)(A组为55.3%; B组为38.6%) %; P mortality> 0.05),总死亡率为33(35.3%:A组,48.9%; B组,22.7%:P <0.05)。死亡原因为脓毒症持续发作(A组11; B组5),麻醉并发症(A组5; B组0)和呼吸系统并发症(A组7; B组5)。延误介绍,设施不足和健康保险计划不完善是这两个群体的挑战。
结论:尽管存在挑战,但团队协作管理可能会在我们的环境中适度改善新生儿手术的效果。解决这些挑战可能会进一步改善结果。

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