Anesthesia & Pain Research

Abstract

Esophageal Atresia Management Issues in Senegal: Mortality is Still High

Traore MM, Ndoye MD, Leye PA, Vallier RN, Bah MD, Diop AD, Gaye I, Ba EB, Ndiaye S, Ndiaye A, Sarr JN, Ndour O, Diouf E

Background: Likewise sub-Saharan african countries, in Senegal the mortality rate related to esophageal atresia is very high despite the efforts directed to neonatal mortality reduction policies. Diamniadio Children’s Hospital is a new structure where these cases are taken care. The purpose of this study is to assess the peri-operative management in a new children’s hospital.

Patients and Methods: An analytical backward study was conducted from January 2016 to July 2019 at Diamniadio Children’s Hospital. We included all neonates undergoing esophageal atresia admitted in the neonatalogy ward. They were followed up until their discharge.

Results: Overall, 20 patients were collected during the study period. Two neonates passed away before surgery. The mean age was at 5days [1-30] with an average weigh of 270kg. A notion of inbreeding was outlined in 11 patients. Maternal mean age was at 25years old. Nineteen newborns were sent by different hospitals and health center maternities and were carried by non-medical ambulance. The diagnostic was set up according to the clinical signs, which none of them were systematically revealed. Type III was present in 90% of cases. The majority was represented by Stage B of Waterston accounting for 65%. Ventilation was not performed for any patient before surgery. The operative time-limit was at 5,44 ± 6,28 with extremes range from 1 to 30 days. All patients underwent a general anesthesia with an intubation for a right-sided thoracotomy. The majority of the operated patients standing for 61,1% were extubated at he recovery room 2hours after intervention. Hospital infections accounted for 55,5% of the complications and were caused by multiresistant germs. Out of 18 operated patients, 4 have died standing for a mortality rate of 77,7%. Death mostly occured in the 5th post-surgical day.

Conclusion: The outcome of esophageal atresia is still worsened by hospital infections et the management delay, in our country.

View pdf