9
7
struction from January 2002 to December 2009. Each
subject on presentation was stabilized as much as possi-
ble with intravenous fluids, antibiotics as deemed neces-
sary and nursing care. Radiological studies with
Table 2: Factors associated with mortality
Age (week)
Outcome
Test of Significance
Discharged LAMA Died
2
<
>
Total
Sex
1
1
13
8
21
3
4
7
11 Likelihood ratio χ = 6.092 df=2
gastrograff in or barium and ultrasound studies could not
be done in most cases. Those considered sufficiently
stable received surgical intervention. Information ex-
tracted from the case notes included biodata, age at pres-
entation, period between presentation and surgical inter-
vention and outcome. Any associated abnormalities
were also noted. Simple proportions and percentages
were used to analyze the data. Fischer’s exact test and
likelihood ratio were used to determine the statistical
significance of differences.
1
p=0.048
12
2
Male
Female
Total
14
7
21
4
3
7
8
4
12
Likelihood ratio χ = 0.225 df=2
p=0.894
Surgical intervention
2
Yes
No
Total
2
19
21
0
7
7
4
8
12
Likelihood ratio χ = 5.332 df=2
p=0.070
Time lapse before surgical intervention
<24hours
>24hours
0
2
0
0
4
LAMA = Left against medical advice
Results
During the study period, a total of 3,853 neonates were
admitted into the Newborn Unit. Out of these 40
Discussion
(
1.03%) presented with clinical features in keeping with
Neonatal intestinal obstruction has been reported as the
commonest Paediatric surgical emergency . In this retro-
2
intestinal obstruction. The male to female ratio among
the neonates who presented with neonatal intestinal ob-
struction was 1.8:1 (χ2 = 0.225, p = 0.894).
spective study over an eight year period neonatal intesti-
nal obstruction occurred in 1.03% of cases seen in the
Newborn Unit of the Paediatrics department in our hos-
pital. This percentage is small compared to the number
of neonates admitted with neonatal intestinal obstruction
in Ife (24.3%) over an eleven year period. This wide
disparity could largely be from the fact that the Univer-
sity of Calabar Teaching Hospital that is meant to be a
referral center also attends to primary and secondary
health care cases. There were more males in this study
than females, though the difference did not reach statisti-
cal significan1c,2e,8.,10Similar pattern has been reported by
Table 1 shows the causes of intestinal obstruction in
study subjects. Imperforate anus followed by Hirsch-
sprung’s disease and intestinal atresia were the common-
est causes. The aetiology could not be determined in
nine (22.5%) of the neonates who either left against
medical advice before appropriate investigation or died
soon after admission. No autopsies were conducted due
to non-consent approval from the parents.
Table 1: Aetiology of intestinal obstruction
other authors
. The greater premium placed on male
Aetiology
Freq (%)
Yes No
Test of Significance
babies in most African societies may partly explain this.
2
Imperforate anus 16 (40%) was found to be the com-
monest cause of neonatal intestinal obstruction in our
center. This is in kee2p,8i,n10g with previous studies in other
Imperforate anus
Hirschsprung’s disease 4(10) 36(18) p=0.001
16(40) 24(12) Likelihood-ratio(χ )=20.45 df=5
Intestinal atresia
Pyloric stenosis
Indeterminate
Associated abnormality 4(10) 36(18)
Total 40(100) 200(100)
4(10) 36(18)
3(7.5) 37(18.5)
9(22.5) 31(15.5)
parts of the country.
Early age at presentation was
significantly associated with mortality. This could be
attributed to severe forms of intestinal obstruction as
well as early onset of neonatal mortality that are associ-
ated with poor neonatal out8comes. A similar trend was
found by Ademuyiwa et al, in Ife. High forms of intes-
tinal obstruction usually present with early clinical
signs.
The outcome variables studied were survival, left
against medical advice (LAMA) and mortality. The
overall mortality among the subjects studied was 30%,
majority (75%) were due to anorectal malformations. A
significant number LAMA before surgery (17.5%). Of
the six that were operated upon, four (66.7%) died while
two (33.3%) survived. (Table 2). Factor significantly
associated with poor outcomes (LAMA and deaths),
were presentation at age less than one week. A signifi-
cant proportion 90.5% was discharged without surgical
intervention.
Nineteen neonates were discharged without surgical
intervention among including nine who had in-
determinate diagnosis. These could have been cases of
high intestinal obstructions that were not determined due
to the lack of facilities for prompt diagnosis as well as
non-mechanical obstructions.
Mortality was high (30%) in those studie8d,1.0 This same
trend has been found in earlier studies.
Only six
neonates 15% had surgical intervention out of whom
four (66.7%) died. Poor outcome in our country has
been attributed to the poor neonatal intensive care