Priorities in Development of Neonatal Surgery in India
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《交互式心脏血管和胸部手术》
Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012,India.
We had prospectively audited outcome of two hundred and sixty one surgical neonates admitted in our unit over a period of one year. One hundred and forty two neonates (54%) presented within the first 48 hours. Babies with surface defects, which were obvious viz., Meningomyelocele invariably presented very early and other babies presented late. Seventy five per cent babies were males and twenty five per cent were females. Ninety per cent of the babies were brought from outside Chandigarh and had to travel long distance on personal transport or public transport. The distances had to be evaluated on the time taken for transportation rather their Km distances. Most of them did not have a pretranspo rtresuscitation or any care during transportation. Fifteen per cent were preterm and sixty seven per cent weighed less than 2500 g. Antenatal period was not supervised in 29% patients. Only 20% of the supervised deliveries had antenatal ultrasound examination. Less than 3% of the babies were referred prenatally with congenital abnormality. The commonest causes of referral were bile stained vomitus, delayed passage of meconium, respiratory distress, excessive oral secretions, difficulty in feeding, delayed passage of urine or absent anal orifice.
The female gender babies were positively discriminated against by the parents in assuring the quality of treatment. The factors that favored survival were birth weight >2.5Kg (p <0.05), absence of tachypnea (Respiration rate <50/m; p<0.05) and SpO2 >94% at admission. Against the requirement of 55 beds, 15 ventilators and 108 nursing staff (as per international norms) we only had 6 ICU beds, 3 ventilators and 26 nursing staff. In order to improve neonatal surgical survival several of these key factors will have to be corrected by the Government of India. Investment in neonatal surgery must be seen as a one-time investment, which results in healthy baby with normal longevity of life. Unless special attention is given by government of India or by UNICEF, WHO and other funding agencies, neonatal surgical mortality will continue to be high in developing countries. Investments on proper antenatal care and antenatal diagnosis will be very effective in improving surgical results.
Acknowledgement
The authors gratefully acknowledge Dr. Ram Samujh and Mrs. Balpinder Kaur for their kind help in the data collection and analysis.
Dr. K.L. Narasimhan,
Associate Professor,
Department of Pediatric Surgery,
P.G.I.M.E.R., Chandigarh 160 012, India(K.L. Narasimhan,)
We had prospectively audited outcome of two hundred and sixty one surgical neonates admitted in our unit over a period of one year. One hundred and forty two neonates (54%) presented within the first 48 hours. Babies with surface defects, which were obvious viz., Meningomyelocele invariably presented very early and other babies presented late. Seventy five per cent babies were males and twenty five per cent were females. Ninety per cent of the babies were brought from outside Chandigarh and had to travel long distance on personal transport or public transport. The distances had to be evaluated on the time taken for transportation rather their Km distances. Most of them did not have a pretranspo rtresuscitation or any care during transportation. Fifteen per cent were preterm and sixty seven per cent weighed less than 2500 g. Antenatal period was not supervised in 29% patients. Only 20% of the supervised deliveries had antenatal ultrasound examination. Less than 3% of the babies were referred prenatally with congenital abnormality. The commonest causes of referral were bile stained vomitus, delayed passage of meconium, respiratory distress, excessive oral secretions, difficulty in feeding, delayed passage of urine or absent anal orifice.
The female gender babies were positively discriminated against by the parents in assuring the quality of treatment. The factors that favored survival were birth weight >2.5Kg (p <0.05), absence of tachypnea (Respiration rate <50/m; p<0.05) and SpO2 >94% at admission. Against the requirement of 55 beds, 15 ventilators and 108 nursing staff (as per international norms) we only had 6 ICU beds, 3 ventilators and 26 nursing staff. In order to improve neonatal surgical survival several of these key factors will have to be corrected by the Government of India. Investment in neonatal surgery must be seen as a one-time investment, which results in healthy baby with normal longevity of life. Unless special attention is given by government of India or by UNICEF, WHO and other funding agencies, neonatal surgical mortality will continue to be high in developing countries. Investments on proper antenatal care and antenatal diagnosis will be very effective in improving surgical results.
Acknowledgement
The authors gratefully acknowledge Dr. Ram Samujh and Mrs. Balpinder Kaur for their kind help in the data collection and analysis.
Dr. K.L. Narasimhan,
Associate Professor,
Department of Pediatric Surgery,
P.G.I.M.E.R., Chandigarh 160 012, India(K.L. Narasimhan,)