Abstract
Objective: To review the challenges in postoperative neonatal outcome in a setup with no ICU.
Methodology: This prospective study of neonates was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2013 to December 2013. The data was analyzed in terms of age, weight, gender, mode of delivery, time & mode of presentation, diagnosis, intervention, outcome and complications.
Results: During the study period, 526 neonates were admitted, of which 376 (71.48%) were operated. Majority of cases presented between 3 to 10 days. The condition encountered were anorectal malformation (131, 34.8%), esophageal atresia (96, 25.25%), gastrointestinal atresia (37, 9.8%), malrotation (26, 6.91%), pneumoperitonium (26, 6.91%), soft tissue infection (25, 6.64%), Hirschsprungs disease (14, 3.7%), abdominal wall defects (10, 2.6%), diaphragmatic hernia (8, 2.1%) and sacrococyxgeal teratoma (3, 0.79%). The overall postoperative survival was 59.04%. Most of neonates died at the 3rd to 5th postoperative day due to sepsis, hypothermia, and electrolytes imbalance. The highest mortality was seen in esophageal atresia (30, 19.48%) followed by complicated intestinal obstruction (53, 34.41%).
Conclusion: Postoperative neonatal survival was 59.04. Sepsis, electrolyte imbalance and hypothermia were the major causes of death. Preterm and low birth weight along with late presentations of neonates contributed to higher rate of morbidity and mortality. We propose that appropriate utilization of the available resources can improve postoperative neonatal survival in Pakistan.

Key words: Neonatal mortality, post operative survival, neonatal sepsis, esophageal atresia.