Clinical profile, management, and outcome of neonates with congenital structural anomalies admitted in neonatal intensive care unit

Abstract

BACKGROUND: The aim of this study was to describe the clinical profile, management, and outcome of neonates with congenital structural anomalies and to determine the proportion of neonates having major and minor congenital structural anomalies and requiring surgical intervention. This retrospective cross-sectional study included all neonates admitted in neonatal intensive care unit of a tertiary health-care referral center over a period of 1 year. Neonates with acquired form of surgical conditions (like abscess and necrotising enterocolitis) were excluded from the study. We also studied various maternal risk factors such as gestational diabetes, amniotic fluid volume, and pregnancy registration. RESULTS: Out of total 1667 admitted neonates during the study period, 157 (9.41%) had congenital structural anomalies, and in only 44 neonates, the anomaly was detected antenatally (28.02%). Majority of anomalies belonged to cardiovascular system (n = 44, 28.02%), followed by equal proportion in genitourinary and central nervous systems (n = 26, 16.56%), and 19 (12.10%) babies had multiple congenital anomalies. The maternal risk factors for structural anomalies included gestational diabetes, oligohydramnios, and number of antenatal visits. Surgical intervention was done in 22 (14.01%) neonates and the rest 135 (85.98%) babies were not operated. The patients who were not operated for their congenital anomalies include those who either died before intervention, or their surgery was deferred because of their poor general condition, babies who were discharged against medical advice or had multiple anomalies where the surgical intervention was not beneficial. Among the study group, 114 (72.61%) neonates were discharged, parents of 6 (3.82%) babies took discharge against medical advice, and 37 (23.56%) newborns succumbed. CONCLUSIONS: This study has highlighted the pattern of congenital malformations with associated maternal risk factors. Health education, regular antenatal visits, and extremely sensitive prenatal screening method are needed for prevention and early intervention for improving the outcome of high-risk pregnancy.