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Corresponding Author

Mohamed M. Abdelghany

Subject Area

Pediatric Surgery

Article Type

Original Study

Abstract

Background: Neonatal intestinal obstruction (NIO) remains a major surgical emergency associated with substantial morbidity and mortality, particularly in low- and middle-income countries. Early identification of neonates at increased risk of adverse outcomes may improve perioperative management and survival. This study aimed to evaluate the etiological spectrum, surgical management, short-term outcomes, and predictors of mortality among neonates undergoing surgery for intestinal obstruction in a tertiary referral hospital in Egypt, with particular emphasis on the prognostic value of perioperative inflammatory markers. Objective: this study aimed to evaluate the causes and early postoperative outcomes among neonates operated for intestinal obstruction in a tertiary referral hospital in Egypt. Methods: A prospective observational cohort study was conducted at a tertiary pediatric surgical referral center between May 2025 and April 2026. Neonates aged ≤28 days who underwent surgical intervention for intestinal obstruction were included. Demographic, clinical, operative, laboratory, and postoperative outcome data were collected. Factors associated with mortality were evaluated using univariate and multivariable analyses. Receiver operating characteristic (ROC) analysis was performed to assess the predictive performance of C-reactive protein (CRP) and platelet count for mortality. Results: Seventy-four neonates underwent surgical intervention for intestinal obstruction. The most common diagnoses were anorectal malformations (24.3%), malrotation (21.6%), and jejunoileal atresia (18.9%). Overall survival was 82.4%, while mortality was 17.6%. Postoperative complications occurred in 40.5% of patients, with sepsis accounting for 73.3% of all complications. Non-survivors had significantly lower gestational age (35.2 ± 2.6 vs. 36.5 ± 2.2 weeks, p = 0.046), lower preoperative platelet counts (255 ± 140 vs. 359 ± 138 ×10⁹/L, p = 0.016), and a higher prevalence of elevated preoperative CRP (76.9% vs. 26.2%, p < 0.001). Mechanical ventilation was required in all non-survivors (p < 0.001). Postoperative CRP levels were significantly higher among non-survivors (51 [35–130] vs. 25 [15–35] mg/L, p = 0.012), while postoperative platelet counts were significantly lower (165 ± 126 vs. 286 ± 116 ×10⁹/L, p = 0.001). ROC analysis demonstrated good predictive performance of postoperative CRP for mortality (AUC = 0.779, 95% CI 0.547–0.984; p = 0.027). A postoperative CRP level >30 mg/L was associated with significantly increased mortality (60.0% vs. 11.1%, p = 0.008). Conclusion: Neonatal intestinal obstruction remains associated with considerable morbidity and mortality in resource-limited settings. Systemic inflammatory response, thrombocytopenia, and postoperative ventilatory support were strongly associated with mortality. Postoperative CRP demonstrated good prognostic performance and may represent a simple, inexpensive, and clinically useful biomarker for early risk stratification and postoperative monitoring of high-risk neonates.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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