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Surgical neonates in a low-resource setting: Baseline nutrition and outcome assessment

  • Stella Nimanya
    Affiliations
    Mulago National Referral Hospita, Mulago Road, Kampala, Uganda and Makerere University, 7062 University Rd, Kampala, Uganda
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  • Phyllis Kisa
    Affiliations
    Mulago National Referral Hospita, Mulago Road, Kampala, Uganda and Makerere University, 7062 University Rd, Kampala, Uganda
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  • Fizan Abdullah
    Affiliations
    Lurie Children’s Hospital Dept of Surgery, And Northwestern University, 225 East Chicago Avenue, Box 63, Chicago, Illinois 60611-2991
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  • Monica Langer
    Correspondence
    Corresponding author. FRCSC, FACS. Ann & Robert H. Lurie Children’s Hospital of Chicago Department of Surgery. Division of Pediatric Surgery. 225 East Chicago Avenue, Box 63. Chicago, Illinois 60611-2991. , +1 312 684 5463.
    Affiliations
    Lurie Children’s Hospital Dept of Surgery, And Northwestern University, 225 East Chicago Avenue, Box 63, Chicago, Illinois 60611-2991
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      Highlights

      • What is currently known about this topic?
      Congenital anomalies that require surgery are highly lethal in low-resource settings.
      • 2.
        What new information is contained in this article?
      Survival improved for gastroschisis and esophageal atresia since previous reports. Measuring weight and electrolytes regularly allows quantification of the malnutrition and frequent electrolyte derangements in these children, which should prompt more frequent testing and treatment of abnormalities in similar settings.

      Summary

      Introduction

      Congenital anomalies necessitating prolonged fasting have a high mortality in low-income settings, partially due to malnutrition and electrolyte disturbances in the absence of parenteral nutrition (PN). Interventions to address these problems require an accurate baseline quantification of the morbidity and mortality of this population. This prospective study aimed to determine peri-operative morbidity, fluid and electrolyte disturbance, growth, and mortality in neonates with gastroschisis (GS), intestinal atresia (IA), and esophageal atresia (EA) in Uganda.

      Methods

      Standardized patient care of 45 neonates treated in Uganda from Oct 2021 to March 2022 with protocolized fluid and nutrition, vital signs, and routine laboratory measurements. Patient demographics, admission and hospital characteristics are described with mean +/-SD. Characteristics of survivors and non-survivors were compared with Fischer’s exact tests, logrank tests, and CoX Ph model.

      Results

      Twenty-eight (62.2%) patients had GS, 4 (8.9%) EA, and 13 (28.9%) IA. Thirty-six percent (16/44) of patients survived to discharge (26% GS, 50% EA, 54% IA) with an average length of stay of 17.3 days (+/- 2.2) (survivors) and 9 days (+/- 1.7) (non-survivors). Average weight was 2.21 kg (+/- 0.62) at presentation, with no significant weight change during the study. Abnormal serum sodium in 64%, phosphate 36.5%, and magnesium 20.8% of measurements. Mortality did not correlate with diagnosis (p=0.47), electrolyte derangement, or weight change.

      Conclusion

      Mortality of neonates born with GS, EA, and IA is high in Uganda. Malnutrition and fluid/electrolyte derangements are common and may affect mortality. This study provides a comparison group for studying interventions to improve outcomes for these populations.

      Keywords

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