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380 Neonatal Intestinal Obstruction

Newer techniques, such as the serial transverse enteroplasty Table 61.1: Evidence-based research.
procedure (STEP), may offer improved bowel function and length in Title Trends in neonatal intestinal obstruction in a developing
some patients. Small bowel transplant, with or without other viscera country, 1996–2005
such as liver and pancreas, is being performed in select centres in the Authors Ekenze SO, Ibeziako SN, Ezomike UO
United States and United Kingdom with varying results.
Institution Department of Surgery, University of Nigeria Teaching
Prognosis and Outcomes Hospital, Enugu, Nigeria
The prognosis for babies with these conditions depends entirely on Reference World J Surg 2007; 31:2405–2409
the delay at presentation, appropriateness of resuscitation, operative Problem Outcome of neonatal intestinal obstruction is poor in Africa
compared to the rest of the world.
and anaesthetic expertise, and most of all on the postoperative care
available. Unless there is a neonatal ICU (NICU), outcome is inevita- Intervention Better resources and expertise and referral to a tertiary
centre may improve results.
bly poor. All efforts in Africa should be spent on improving transport
to hospital and postoperative care. Comparison/ A comparative analysis was performed involving 128
control consecutive NIO cases managed from January 1996 to
Prevention (quality of December 2005 at the University of Nigeria Teaching
The improvement of antenatal care and early transport to a tertiary evidence) Hospital, Enugu, in southeast Nigeria. Fifty-five (43.0%)
neonates were managed in the first five years (group A), and
centre may improve the management and outcome of babies with the 73 (57.0%) in the last five years (group B). The aetiology
above-mentioned congenital abnormalities. There seems to be some of obstruction did not vary significantly in the two groups.
evidence that folic acid may decrease the incidence of ARM. Average duration of symptoms before presentation fell from
5.9 days (group A) to 4.7 days (group B). With the exception
of Hirschsprung’s disease, all other cases required operative
Evidence-Based Research treatment. In HD, the colostomy rate declined from 44.4%
(group A) to 26.7% (group B). More neonates in group B
Table 61.1 presents a comparative analysis of neonatal patients with were managed with general anaesthesia and perioperative
intestinal obstruction in two groups treated during five-year consecu- third-generation cephalosporin antibiotics (p = 0.01). Although
the complication rate did not vary significantly in the two
tive periods to track the trends in management. groups (group A, 42%; group B, 40.3%), survival improved
(group A, 61.8%; group B, 72.6%). Earlier presentation,
improved manpower, and use of potent antibiotics may have
contributed to the improved outcome.
Outcome/ Challenges in the form of lack of neonatal intensive care
effect facilities and dearth of qualified personnel persist. There is
a trend toward earlier presentation and increased survival of
babies with NIO. Improving the existing facilities and trained
manpower, and establishing collaboration with centres that
have excellent results may further encourage the trend.
Historical Survival of neonates in Africa with intestinal obstruction can
significance/ improve from 50% to above 90%, as reported in the well-
comments resourced part of the world, if the above challenges are met.

Key Summary Points

1. Neonatal intestinal obstruction is one of the most common 5. Radiological contrast and histopathological studies further aid in
neonatal surgical emergencies. the diagnoses.
2. Successful management of NIO depends on timely diagnosis 6. Catastrophic events such as volvulus, ischaemic loop of bowel,
and referral for therapy. pneumoperitoneum, and or pneumonia from aspiration and
malnutrition, could be overcome through efficient and timely
3. The diagnosis is made based on clinical findings of bile-stained resuscitation and urgent transport to a specialised unit.
vomiting, degrees of abdominal distention, and failure to pass
meconium. 7. Outcomes are resource- and expertise-dependent.
4. Plain radiographs assist in most diagnoses.

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