Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: The most common surgical conditions in the newborn involve the gastrointestinal tract. The outcome of neonatal surgical emergencies has steadily improved in developed countries. This has been attributed to a better understanding of neonatal physiology, improvement in specialist surgical and anesthetic manpower, improved diagnostic facilities and neonatal intensive care. Objective: The aim of this study was to detect the incidence of congenital and acquired GIT problems in neonates admitted in the SNICU. Also, it was undertaken to determine complications and contributing factors to mortality in SNICU. Results: A total of 229 neonates were studied. Congenital GIT conditions were found in 92% of neonates. Neonatal intestinal obstruction was the predominant congenital GIT surgical condition (28%), followed by EA/TEF (21.8%) and abdominal wall defects (11.8%). The mortality rate was 32.3% (74 neonates). Abdominal wall defects had higher mortality (59%), followed by EA/TEF (46%) and intestinal obstruction (39%). Congenital hypertrophic pyloric stenosis had 100% survival. Cardiovascular instability (p= 0.004; OR: 9.994, 95% CI: 2.103-47.497), need for mechanical ventilation (p= 0.001; OR: 68.746, 95% CI: 13.108-360.546), development of NEC (p= 0.018; OR: 7.096, 95% CI: 1.402-35.927) were predictors of the mortality, while enteral feeding was a significantly associated with good outcome (p= 0.008; OR: 0.003, 95% CI: 0-0.21). Conclusion: Delayed post-operative enteral feeding was a significant predictor of mortality. Other factors associated with mortality are mechanical ventilation and its complications, cardiovascular instability and development of postoperative NEC

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