Background: Neonatal surgical conditions account for 11%of the Global Burden of Diseases (GBD), and neglecting their management has been reported though most are amenable to surgery. Timely surgical interventions play a major role in determining better outcomes, thus improving quality of life and reducing disability. Several factors including sepsis control, care in newborn intensive care unit and availability of total parenteral nutrition have been shown to improve the outcomes of neonates with surgical conditions. Objective: To evaluate the outcomes of neonates with conditions requiring surgical interventions. Methods: A prospective descriptive study was done in the Newborn Unit, Moi Teaching and Referral Hospital (MTRH). Data on the following study variables were obtained and analyzed: maternal age, place and mode of delivery, newborn’s age at admission, birth weight, surgical condition, co-morbid conditions, treatment outcomes (discharge, death or referral to Kenyatta National Hospital for specialized care), surgical complications, time-to-initiation of oral feeds post-operatively, antenatal history and laboratory parameters; and length of hospital stay. Results: A total of 124 neonates were recruited, with a male to female ratio of 1.1:1 and median age at admission was 2 days (IQR 1, 5). Most (59.7%) were in the birth weight range of 2.5–3.9kg.

Background: Gastroschisis is an anterior abdominal wall defect occurring in up to 4 babies per 10,000 live births. Though the anomaly is rarely associated with other disorders, it poses serious pathophysiological challenges that negatively affect outcome. Review of the management of gastroschisis at Moi Teaching & Referral Hospital (MTRH) from 2013-2016 was done to determine the outcome.

Materials and Methods: A four year (2013-2016) retrospective review of gastroschisis management at MTRH was undertaken. Theatre records were used to track all files of babies admitted and operated on. The primary outcome of data analysis was survival. Secondary outcomes analyzed were age at admission, maternal age, birth order, associated anomalies and complications.

Results: Records that were available for analysis were 107. Males were 58 (54%). Male to female ratio was 1.1:1. Mean age at admission was 1.35 ± 0.06 days. Weight ranged from 1250-3800 gm with a mean of 2330 gms. Majority were first born. Mean maternal age was 21.25 ± 3.62 years. Complex gastroschisis occurred in 12 (11%). Overall survival was 43%. However, of those who reached the stage of definitive treatment of containment (either primary closure or staged silo placement), had 48% survival rate. Survival rate was highest in the group who weighed 2500 gms and above. Poor outcomes were noted in the premature and low birth weight neonates, and those with complications. Sepsis was the leading cause of mortality. Length of hospital stay was an average of 24 days for the survivors.

Conclusions & Recommendations: Prematurity, low birth weight, and complications negatively influenced survival. Improving obstetric care, establishment of paediatric surgical centres and neonatal support services are key to turning around the survival of neonates with this severe surgical anomaly.

PurposeWilms tumor is the commonest renal malignancy in childhood. Survival in high-income countries is approximately 90%, whereas in low-income countries, it is less than 50%. This study assessed treatment outcomes of patients with Wilms tumor at a Kenyan academic hospital.Patients and MethodsWe conducted a retrospective medical record review of all children diagnosed with Wilms tumor between 2010 and 2012. Data on treatment outcomes and various sociodemographic and clinical characteristics were collected.ResultsOf the 39 patients with Wilms tumor, 41% had event-free survival, 31% abandoned treatment, 23% died, and 5% had progressive or relapsed disease. Most patients presented at an advanced stage: stage I (0%), II (7%), III (43%), IV (40%), or V (10%). The most likely treatment outcome in patients with low-stage (I to III) disease was event-free survival (67%), whereas in those with high-stage (IV to V) disease, it was death (40%). No deaths or instances of progressive or relapsed disease were recorded among patients with low-stage disease; their only reason for treatment failure was abandonment of treatment. Stage of disease significantly affected treatment outcomes (P = .014) and event-free survival estimates (P < .001). Age at diagnosis, sex, duration of symptoms, distance to hospital, and health insurance status did not statistically significantly influence treatment outcomes or event-free survival estimates.ConclusionSurvival of patients with Wilms tumor in Kenya is lower compared with that in high-income countries. Treatment abandonment is the most common cause of treatment failure. Stage of disease at diagnosis statistically significantly affects treatment outcomes and survival.