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Abstract

Background: Neonatal surgical conditions are a major contributor to infant morbidity and mortality, particularly in resource-constrained settings. The delicate physiology of neonates, coupled with prematurity and low birth weight, increases the complexity of surgical management. Timely identification, appropriate referral, and availability of specialized care are crucial to improving outcomes. Despite technological advancements, neonatal surgical mortality remains high in many developing countries due to systemic limitations and variability in clinical practices.
Objective: To evaluate the clinical spectrum, outcomes, and determinants of survival in neonatal surgical cases managed at a tertiary care hospital.
Methods: This analytical cross-sectional study was conducted at Combined Military Hospital (CMH) Rawalpindi from August 1, 2023, to January 31, 2025. A total of 444 neonates with surgical conditions managed by the pediatric surgery department were enrolled using convenience sampling. Neonates undergoing non-operative procedures or managed by other surgical specialties were excluded. Data were collected on age, gender, gestational age, birth weight, diagnosis, surgical intervention, and outcomes. SPSS version 21 was used for statistical analysis. Associations between clinical variables and outcomes were analyzed using Chi-square tests, with significance set at p < 0.05.
Results: Of 444 neonates, 263 (59.2%) were discharged, 167 (37.6%) expired, and 14 (3.2%) were transferred. Digestive system anomalies were most common (109 cases, 24.5%), followed by cardiovascular defects (102, 23.0%) and neurosurgical conditions (86, 19.4%). Preterm neonates (127, 28.6%) and low birth weight infants had significantly higher mortality (p = 0.001 and p = 0.000, respectively). Referred patients (outdoor) had better survival rates (p = 0.009), while gender and delivery mode showed no significant impact on outcomes (p > 0.05).
Conclusion: The study underscores the high burden and mortality of neonatal surgical cases, particularly among preterm and low birth weight neonates. Strengthening early diagnosis, timely surgical intervention, and expanding specialized neonatal surgical care are critical to improving outcomes in such high-risk populations.