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Introduction: Neonatal surgery is complex and time-sensitive, with a narrow margin for error. While neonatal surgical conditions account for approximately 11% of the global disease burden, data on their impact in Ethiopia remains limited. Methods: A hospital-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital by reviewing medical records of 268 neonates who underwent surgery between 2017 and 2023. Data were analyzed using Stata version 14. Multivariable logistic regression was used to identify predictors of mortality. Statistical significance was set at P < .05. Results: The overall mortality rate was 14.18%. Key predictors of mortality included preoperative sepsis (AOR: 4.45; 95% CI: 1.49-13.27), postoperative hypothermia (AOR: 3.19; 95% CI: 1.17-8.71), low birth weight (AOR: 3.7; 95% CI: 1.12-12.43), preterm birth (AOR: 3.88; 95% CI: 1.04-14.46), and prolonged hospital stay (AOR: 3.34; 95% CI: 1.15-9.84). Conversely, neonates aged 9 to 28 days had significantly lower odds of death (AOR: 0.22; 95% CI: 0.05-0.998). Conclusion: Neonatal surgical mortality was significantly influenced by preoperative, intraoperative, and postoperative factors. Targeted interventions focusing on infection control, thermal regulation, and care of preterm and low birth weight neonates may improve outcomes.

Background: Mortality in surgical neonates contributes to neonatal mortality rates. The study was conceptualized to study clinical and nonclinical factors affecting mortality in surgical neonates so that timely intervention could result in improved survival of the neonates. Materials and Methods: The study was initiated after approval from the institutional ethics committee and included 120 surgical neonates over a period of 18 months after obtaining consent from the parents/caregivers. Predesigned pro forma was used to record the details of antenatal care received, place of birth, travel history, maternal education and gestational age, and clinical condition at the time of admission. Values of biochemical tests such as serum electrolytes, serum creatinine, and arterial blood gasses were recorded. The need of inotrope support, blood or blood product transfusion, and postoperative ventilator support and intensive care unit (ICU) care was recorded. The results of the two groups, i.e., survivals and mortality, were compared. Outcome was recorded as mortality at 30 days or earlier. Results: Irrespective of the surgical condition, the survival rate was significantly better in those babies who weighed more than 2.5 kg at the time of admission, had capillary refill time of <3 s, had serum ionized calcium levels more than 1 mmol/L, and did not require inotropes, blood or blood product transfusion, and postoperative ICU care and ventilator support. The place of birth, educational status of the mother, gestational age, and distance traveled for care had no statistically significant effect on survival. Conclusion: There is a statistically significant correlation between the survival of the babies who weighed more than 2.5 kg and are more physiologically preserved at the time of admission. Mortality rates can be decreased by timely interventions to reduce the need of inotropes, blood or blood products, and ICU care and ventilator support during their postoperative recovery.

Purpose: The aim of this research is to study the predictors of neonatal surgical mortality (NSM)-defined as in-hospital death or death within 30 days of neonatal surgery. Materials and Methods: All neonates operated over the study period of 18 months were included to evaluate NSM. The evaluated preoperative and intraoperative variables were birth weight, gestation age, age at presentation, associated anomalies, site and duration of surgery, intraoperative blood loss, and temperature after surgery. Assessed postoperative variables included the need for vasopressors, postoperative ventilation, sepsis, reoperations, and time taken to achieve full enteral nutrition. Univariate and multivariate logistic regression was applied to find the predictors of mortality. Results: Based on patient's final outcome, patients were divided into two groups (Group 1-survival, n = 100 and Group 2-mortality, n = 50). Incidence of NSM in this series was 33.33%. Factors identified as predictors of NSM were duration of surgery >120 min (P = 0.007, odds ratio [OR]: 9.76), need for prolonged ventilation (P = 0.037, OR: 5.77), requirement of high dose of vasopressors (P = 0.003, OR: 25.65) and reoperations (P = 0.031, OR: 7.16 (1.20-42.81). Conclusion: NSM was largely dependent on intraoperative stress factors and postoperative care. Neonatal surgery has a negligible margin of error and warrants expertize to minimize the duration of surgery and complications requiring reoperations. Based on our observations, we suggest a risk stratification score for neonatal surgery.

Unexpected cardiac arrest in the perioperative period is a devastating complication. Owing to immaturity of organ systems, and presence of congenital malformations, morbidity and mortality are higher in neonates. There is abundant literature about early recognition and management of perioperative adverse events in children, but similar data and guidelines for surgical neonates is lacking. The current neonatal resuscitation guidelines cater to a newborn requiring resuscitation at the time of birth in the delivery room. The concerns in a newborn undergoing transition from intrauterine to extra uterine life is significantly different from a neonate undergoing surgery. This review highlights the causes and factors responsible for peri-arrest situations in neonates in the perioperative period, suggests preoperative surveillance for prevention of these conditions, and finally presents the resuscitation protocol of the surgical neonate. All these are comprehensively proposed as Neonatal Peri-operative Resuscitation (NePOR) protocol.

Background The protrusion of cranial contents via a skull defect is known as an encephalocele. Unlike western countries where occipital encephalocele dominates, anterior encephaloceles are the most common types of encephalocele in Southeast Asia, parts of Russia, and Central Africa. We present the clinical presentation and surgical management of an 8-day-old infant with frontoethmoidal encephalocele. Case presentation An 8-day-old neonate born to a 24-year-old mother with no antenatal follow-up was referred with a compliant of frontonasal swelling which was present since birth. Physical examination of the neonate revealed a cystic lobulated swelling over the upper edge of the nasal bridge. Computed tomography imaging showed an anterior skull defect, resulting in frontonasal meningoencephalocele. The patient underwent a one-stage operation, which combined nasal-coronal approach with frontal craniotomy, to remove the dysplastic tissue and reconstruct the defect. The patient had successful recovery period with acceptable cosmesis. Conclusion We presented a case of frontoethmoidal encephalocele, which is rare in western countries but whose incidence is relatively higher in African countries. Perinatal care is necessary for prevention and early detection of such cases. Direct surgical repair is still the main mode of intervention.

To report the outcome of commonly used antibiotic combinations in surgical neonates in sub-Saharan African settings. A retrospective analysis that determines the outcome of commonly combined antibiotics in surgical neonates between January 2006 and December 2008 at two referral paediatric surgical centres in Benin city was carried out. Ampicillin ampiclox, metronidazole, gentamicin, cefuroxime and ceftriaxone were variously combined in the management of 161 neonates with a mean age at presentation of 9.2 ± 2.6 days, mean weight 3.1 ± 1.4 kg and a male:female ratio 1.6:1. Polymicrobial postoperative wound infections and sepsis caused by Staphylococcus aureus, Escherichia coli, Neisseria meningitidis, Klebsiella pneumonia, Pseudomonas aeroginosa and anaerobes, were mainly encountered. The most common aerobes isolated from wound cultures were S. aureus and P. aeroginosa while the ones from that of blood cultures were E. coli and K. pneumonia. Overall postoperative infections recorded were: wound infection 19 (11.8%), sepsis 16 (9.9%) and sepsis-related deaths 6 (3.7%). Combinations of gentamicin/metronidazole/cefuroxime and gentamicin/cefuroxime were adequate for gastrointestinal and extra-gastrointestinal neonatal operations, respectively, in these sub-Saharan African settings, which may be useful in similar regions.

Africa has one of the highest neonatal mortalities in the world, for which the commonest causes do not include surgical conditions such as some congenital anomalies that are amenable to surgery but are not often operated on because of a number of challenges. These challenges include cultural beliefs and practices, dearth of human resource capacity, inadequate laboratory and imaging support and lack of consumables and intensive or high dependency care facilities. Some of these challenges will be examined and highlighted using the acronym \"ASKS\" in this article.

Quantification of surgical sepsis was never done beyond superficial, subfascial, and deep surgical site infection (SSI). Invasive surgical sepsis with systemic manifestation has not been tried to be quantified in general and pediatric surgery in particular. Hence, this attempts to develop a novel grading system to quantify neonatal surgical infections. Predisposing factors, infection, response, and organ failure (PIRO) is being used in critical care institutions for medical sepsis; it was modified with neonate-specific surgical parameters. Authors have developed a grading of these parameters into Grade I, II, and III. A blinded statistical test was performed and results were put to test. Extended Mantel-Haenszel Chi-square test validated linear relationship with grade and outcome, hospital stay, deep SSI, and organ dysfunction. Analysis of variance also showed the significant relationship of changing trends in grade and outcome. (1) Higher the grade indicated the probability of death. (2) Grade I patients had less duration of hospital stay compared to Grade II and III ( = 0.04). (3) The requirement of organ support and SSI were also more in Grade III. (4) Grade I patients had less increase in trends compared to Grade II and III (F = 4.86). Authors therefore feel Neo-PIRO seems to be the first scoring system that shows a linear relationship between scores and grade. Neo-PIRO is a novel grading system with surgical neonate-specific parameters. Future versions to include molecular parameters, as well as parameters selected by regression analysis.

Objective: Post operative sepsis in neonates is a serious problem that may be challenging to diagnose. It is standard practice at our Neonatal Intensive Care Unit (NICU) in Pakistan to perform routine Blood Cultures (BLCS) and C-Reactive Protein (CRP) to screen for post-operative sepsis. We aimed to review this practice to investigate its effectiveness at screening for post-operative sepsis. Methodology: All neonates admitted to the NICU post-operatively at our center from 2017-2022 were included. Relevant clinical and demographic data were collected. The sensitivity of BLCS was calculated for each post-operative day (POD) and an ROC curve was constructed for overall CRP values to quantify their screening value. Results: A total of 109 post-operative neonates were included (median gestational age 37 weeks, birth weight 2.4kg). Thirteen (12.6%) developed sepsis. Only two patients had pathological microbe growth on POD 0 or 1, both having growth preoperatively. BLCS sensitivity increased significantly after POD 2. CRP performed poorly at discriminating post-operative sepsis (AUROC=0.55). Conclusion: Routine BLCS performed immediately after surgery did not predict the onset of post-operative sepsis. CRP performed poorly at discriminating post-operative sepsis, likely due to physiologic inflammation in post-operative neonates. Unnecessary screening tests represent a significant financial burden in LMICs, with little clear clinical benefit.

In this trial involving women who received standard antibiotic prophylaxis for nonelective cesarean section, the risk of infection after surgery was lower with the addition of azithromycin than with placebo. Globally, pregnancy-associated infection is a major cause of maternal death and is the fourth most common cause in the United States. 1 Maternal infection is also associated with a prolonged hospital stay and increased health care costs. 2 , 3 Cesarean delivery is the most common major surgical procedure 4 and is associated with a rate of surgical-site infection (including endometritis and wound infection) that is 5 to 10 times the rate for vaginal delivery. 5 Despite routine use of antibiotic prophylaxis (commonly, a cephalosporin given before skin incision 6 ), infection after cesarean section remains an important concern, particularly among women who undergo nonelective procedures . . .