Neonatal gastrointestinal obstruction : 17 years of single-institution experience

Background Gastrointestinal obstruction in newborns is a life-threatening condition caused by anatomical abnormalities that lead to failure to defecate. This is the most common surgical emergency for newborns. Prompt diagnosis, intervention, and implementation of appropriate management methods are important to improve outcomes in neonates with intestinal obstruction. This study aimed to explore the clinical characteristics and causes of gastrointestinal obstruction in a tertiary neonatal intensive care unit in Taiwan. Neonatal clinical and demographic characteristics, final diagnosis, surgical complications, and mortality were recorded. Methods This was a retrospective study conducted in a tertiary care medical center from May 2007 to November 2024. A total of 101 neonatal patients younger than 28 days of age who presented with gastrointestinal obstruction and underwent surgical intervention were enrolled. Results A total of 101 newborns were included in this study, with a male-to-female ratio of 1.8:1 and an average age of 4.4 days. The gestational age ranged from 24 to 40 weeks, with an average of 32.3 weeks, including 58 (57.4%) full-term infants and 43 (42.6%) premature infants. Birth weight ranged from 633 to 3675 g (average = 2425 g). Initial clinical manifestations included abdominal distension, bilious vomiting, and decreased activity levels. The mean age at presentation was 5 days, and the most common cause of intestinal obstruction was Hirschsprung disease (HD), which was observed in 23 (22.7%) cases. Other causes included 16 cases (15.8%) of malrotation, 11 cases (10.9%) of congenital diaphragmatic hernia (CDH), 11 cases (10.9%) of duodenal obstruction, 9 cases (8.9%) of meconium ileus, 8 cases (8%) of Meckel diverticulum, 6 cases (5.9%) of anorectal malformation (ARM), 6 cases (5.9%) of esophageal atresia, 3 cases (2.9%) of inguinal hernia, 2 cases (1.9%) of idiopathic hypertrophic pyloric stenosis (IHPS), 1 case (0.9%) of jejunal atresia, 1 case (0.9%) of duplication cyst, and 4 other cases (3.9%). After surgical correction, five patients died due to necrotizing enterocolitis, ileal perforation,and sepsis. Conclusion Morbidity and mortality from neonatal gastrointestinal obstruction have improved in recent years. In this study, we found that prenatal diagnosis, early referral, improved surgical techniques, and adequate staffing and postoperative care are critical for good outcomes.