Neonatal surgical mortality and morbidity at the University Teaching Hospital of Kigali, a tertiary university hospital in Rwanda: analysis of predicting factors

INTRODUCTION: Globally, high morbidity and mortality is associated with neonatal surgical conditions. This study aimed to determine the factors influencing the mortality in neonates with surgical conditions at Centre Hospitalier Universitaire de Kigali (CHUK). METHOD: This was a prospective study from October 2019 to March 2020. Analysis of patients was divided based on a diagnosis of gastroschisis versus non-gastroschisis conditions. Odds ratios were calculated at a confidence interval of 95%. Factors with p-value <0.05 on bivariate analysis were considered. RESULTS: Eighty-two neonates were enrolled. 45.1% were admitted within the first 24 hours of life, 61% were males, 26.9% were preterm, and 51.2% had birth weight less than 2500g. Gastroschisis (n=43, 52.4%) was the most common diagnosis, followed by intestinal atresia (12.2%). The overall mortality rate was 57%. Mortality was more likely to occur among neonates with gastroschisis compared to neonates with non-gastroschisis surgical conditions (76.7% vs 35.9%, OR=5.893, p<0.001). Among neonates with gastroschisis, factors associated with mortality were the failure of initiation of enteral feeding (100%, p=0.002) and sepsis (82.5%, p=0.001). Among neonates with non-gastroschisis surgical conditions, factors associated with mortality were prematurity (87.5%, OR:24, p=0.001), low birth weight (72.7% vs 21.4%, p=0.003), initiation of enteral feeding at more than 48 hours (33.3% vs 25.8%, p=0.006), sepsis (64.7% vs 13.6%, OR:11.61, p<0.001), and need of mechanical ventilation (63.6% vs 25%, OR:5.25, p=0.024,). CONCLUSION: Neonatal surgical mortality is still a burden and has many predicting factors. Improvement and advocacy are needed to reduce neonatal mortality.