Neonatal Surgical Emergencies in a Tertiary Care Center

Background: Congenital anomalies those are incompatible with life unless they are corrected. They constitute the primary justification for pediatric surgery specialty because they demand experienced judgment in early diagnosis, expeditious management as well as highly refined operative technique and post-operative care. Materials and Methods: The clinical material in the present study consists of 124 neonates admitted to pediatric surgical ward of Medical College hospital, Jabalpur from 1st January 2011 to 31st July 2012. Results: Incidence of neonatal surgical emergency was 12.3% among all pediatric surgical admission, i.e. 124 cases in 1007 admissions. The most common neonatal emergency was constituted by gastrointestinal group observed in 49.1% cases. Next in order of frequency was skin defect, i.e., in 25.8% cases followed by respiratory emergency observed in 13.7% cases. Anorectal malformation was the most common cause of gastrointestinal emergency (63.5%). Out of total 35 cases gastrostomy alone was performed in 2 cases, gastrostomy along with ligation and division of trachea-esophageal fistula was performed in 1 case. Transverse colostomy alone in 26 (74.2%) cases and along with gastrostomy in 1 case. Ileostomy and nephrostomy were performed in 1 case each. Ligation and division of tracheoesophageal fistula and end to end anastomosis was done in 5 cases, in which general condition, of patient was good. Excision and repair of meningomyelocele and meningoencephalocele was possible only in 9 (45%) cases out of 20 cases. The mortality in surgical treated patients was (30%), i.e., 27 out of 90 patient treated surgically. Conclusion: There is a need to improve on neonatal surgical diagnosis and care at both primary and secondary health facilities to promote early referral of neonates to these centers. Skilled and dedicated staff with improved infrastructural facilities such as ventilators, a specialized neonatal surgeon, and operating theater and intensive care unit (NICU) will greatly minimize complex problems.