Factors that predict mortality of jejunoileal atresia in neonates in Baghdad 2010-2012

Abstract EN

Background :Jejunoileal atresia and stenosis are the most common congenital anomalies of the small intestine and are a major cause of intestinal obstruction in neonates.

Late intrauterine mesenteric vascular occlusions is the most accepted hypothesis as an etiology of jejunoilealatresia .

Objective :To describe the mortality rate of 64 patients with intestinal atresia between October 2010 and September 2012 and submitting initial scoring system of 50 points based on the estimated risk scores and P.value of each risk factors.

Methods :A prospective study of mortality rate in jejunoileal atresia according to the patients' parameters (prenatal diagnosis, prematurity , birth weight , age and severity of presentation , associated anomalies ,anatomic location and type of atresias,surgical techniques, early postoperative complications and re- interventions) .

Results :There were 64patients with jejunoileal atresia (35 male).

Prenatal diagnosis was established in 5 patients (8%).

The mean birth weight was 2.6 kg and higher mortality rate with lower birth weight.

The mean gestational age was 37 weeks and 20% of the patients were premature.

Thirty seven patients were presented to medical services in the first three days of life with lowest mortality rate, patients who were presented later had rate of death of 27%-60%.

Sepsis and/or pneumonia were found in (22%) of patients clinically diagnosed with mortality rate (43%).

Seventeen patients (26.5%) had different associated anomalies with related mortality of (53%).

The highest mortality was related to high jejunal atresia (50% ).

Apple-peel & multiple atresias variants of jejunoileal atresia had the highest rates of mortality, 75% &43% respectively.

The mortality rate of the 40 patients with end to obligue anastomosis with plication of proximal atretic dilated segment was 12.5%, while it was 58 % to that without plication of proximal atretic dilated segment.

Nineteen patients (29.5%) were presented with early postoperative complications.

Anastomotic complications (leak & non–functioning anastomosis ) & short bowel syndrome were the major contributor to the related mortality rate (58%) .A surgical re-exploration was done in nine patients with high mortality rate (55.5%).The overall mortality was 16/64 patients (25%).Estimated risk scores and P.values for each factors were obtained.

Scoring system of 50 points was developed according to these above values .

Conclusion: The overall mortality rate in the current study was 25%.

The higher mortality rate was associated with those who had major risk factors compared to the lowest mortality rate of those with minor or no risk factors.

According to estimated risk scores and P.values, cumulative scoring system was submitted .

Late presentation,late diagnosis, absence of well trained neonatal intensive care personnel and unavailability parenteral nutritional support were the major problems that contributed to this high death rate