Outcome of Declined Neonatal Surgical Referrals at Cairo University Specialized Pediatric Hospital
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In brief
In brief
Prospective study from Cairo documenting that 42% of 668 neonatal surgical referrals were declined due to capacity constraints, with 42.5% of declined cases resulting in death. Esophageal atresia and bowel obstruction were the most common conditions, highlighting critical gaps in surgical access for newborns in resource-limited settings.
Written by the GCMD Library team from the article.
Background
The combination of a high birth rate and limited resources leads to a strain on health services with dire consequences to the patient. This study aimed to track the outcome of declined referrals at the tertiary center in the Cairo University Specialized Pediatric hospital.
Methods
Data were collected prospectively on all declined surgical neonates at the tertiary center. The families were later contacted to document outcomes. Verbal consent was taken.
Findings
Over a 12 month period from January 2017 to December 2017, 668 neonatal surgical referrals were received. Of these 278, (41·6%) were declined for lack of available places. The majority were cases of esophageal atresia with tracheoesophageal fistula (35%), followed by bowel obstruction (21%). Thirty-six cases were lost to follow up. Of the remaining 242 cases, 103 (42·5%) died, 63 (26%) were referred to public hospitals, 69 (28·5%) to private hospitals and seven (2·8%) were managed conservatively.
Conclusions
Nearly half of neonatal surgical cases die while waiting for surgical intervention. Cases were shared equally between the public and private sector. The collected data are crucial in planning service provision for neonates requiring surgical treatment. To the best of our knowledge, this is the first study from Egypt and the region to report the number and outcome of surgical neonates who do not get access to expert surgical services. The study outlines the burden of disease faced by a single pediatric surgery unit and documents the various congenital anomalies encountered as well as their outcome when treated elsewhere.
Study type
Prognosis study.
Level of evidence
IV