NEONATAL SURGICAL CHALLENGES: A PROSPECTIVE STUDY FROM A TERTIARY CARE CENTRE

Abstract

Background Neonatal congenital anomalies that demand surgical correction are a major, under-recognised contributor to global under-five mortality. Early antenatal detection, streamlined referral, and specialist peri-operative care are pivotal to survival, yet data from low- and middle-income countries remain sparse.

Methods We undertook a prospective observational study in the neonatal intensive-care unit (NICU) of Saveetha Medical College, Chennai, from December 2022 to February 2025. All in-born and out-born neonates (< 28 days) with confirmed congenital surgical conditions were enrolled. Demography, antenatal factors, lesion spectrum, interventions, complications and six-month outcomes were recorded. Categorical variables were analysed with χ²/Fisher’s exact test; predictors of mortality were explored with multivariable logistic regression (SPSS v25; p < 0.05 significant).

Results Of 3 565 live births, 75 neonates (2.1 %) had surgical anomalies. Gastro-intestinal (GI) malformations predominated (21.3 %), followed by genito-urinary (17.3 %) and neurosurgical (16 %) lesions. Surgery was performed in 44 cases (58.7 %). Overall mortality was 37.3 % (28/75). Prematurity (aOR 3.1, 95 % CI 1.4–6.9), extramural birth (aOR 2.6, 1.1–6.4), multiple anomalies (aOR 2.4, 1.0–5.9), need for ventilatory (aOR 4.9, 2.0–11.8) or inotropic support (aOR 3.7, 1.5–9.4) and postoperative complications (aOR 5.3, 2.1–13.3) independently predicted death.

Conclusion Neonatal surgical mortality in our setting remains unacceptably high. Strengthening antenatal ultrasound programmes, ensuring safe delivery at surgical–NICU hubs, and optimising peri-operative critical care could halve these deaths.