Neonatal period is a critical time for infants, and ⅔ of first-year mortality occurs during this period. In developing countries, surgical diseases are the most important cause of neonatal mortality. Mortality was reduced in the past decade due to the availability of well-trained pediatric surgeons and the development of sophisticated instruments. Inguinal hernia is one of the most common surgical problems of infancy and childhood. It occurs in 0.8–4.4% of children ; however, in premature infants, the incidence may increase to 30%, depending on the age of the gestation . The aim of this study was to evaluate the mortality and survival rates of most common surgical anomalies in our institute in the period when there were no pediatric surgeons compared with the period when there were well-trained pediatric surgical staffs.
Patients and methods
This is a retrospective study, in which files of all neonates admitted in the Imam Khomeni Hospital and Abuzar Pediatric Center during the period 1993–1996 (period 1) and 2002–2005 (period 2) were studied. Patients discharged before treatment or who expired before data accumulation was completed were excluded from our study. In the first period of study, no pediatric surgeon was available. In the second period of study, pediatric surgeons worked in the university hospital as academic staff. Data were statistically analyzed using SPSS Software version. 13 (Chicago, Illinois, USA) and χ2-test was used to compare noncategorical data. A P value of less than 0.05 was considered to be significant. This study was approved by the hospital ethics committee.
In our study, 88 cases (males=60.2%, females=39.8%) in the first period and 452 cases (males=61.7%, females=38.3%) in the second period were included. The mean age at admission time in the first and second period was 6 days for both groups. The mean weights for the first and second period were 2886±766 g and 2915±658 g, respectively. The mean lengths of hospital stay for the first and second period were 5 days and 10.5 days, respectively. In the first period, 68 cases (37.3%) were admitted in the first 7 days of life and 54 cases (61.4%) had a birth weight of 2500–3500 g. Of the 88 cases, 40 cases died (45.5%). In the second period, 353 cases (78.1%) were admitted in the first 7 days of life and 278 cases (61.5%) had a birth weight of 2500–3500 g. Of the 452 cases, 101 cases died (22.3%). Mortality rate was significantly lower in the second period of study compared with the first period (P value=0.000006) (Tables 1–3).
Mortality rate was higher in the first period of study than a study carried out in Ethiopia (30%), and in the second period, the mortality rate was less . Mortality in our study in the second period was similar to studies carried out in Nigeria  (21.1%) and Iraq (22%) . The most common surgical pathology in both periods was imperforate anus and this is similar to studies carried out in Ethiopia, Nigeria, and Iraq [1–3]. Imperforate anus, esophageal atresia with or without associated TEF, and jejunoileal atresia were the most common anomalies in the first period. Imperforate anus, esophageal atresia with our without associated TEF, and Hirschsprung's disease were found to be the most common anomalies in the second period of study. These findings are similar to that of Tefera et al's  study. In our study, the second most common anomaly in both periods was esophageal atresia with or without associated TEF with a rate of 13.6% and 15% in the first and second period, respectively.
In our study, mortality rates were 75% and 58.8 in the first and second period, respectively. Tefera et al.  reported 91.7% mortality for esophageal atresia. In Peyvasteh et al.  the mortality rate was 29.16% (21 patients died, 2 patients were excluded, and 51 cases were included) from 74 cases with esophageal atresia. Hirschsprung's disease was the fourth most common anomaly during the first period and the third most common anomaly during the second period of study. In the study carried out in Nigeria, 7.3% of cases had Hirschsprung's disease . In a previous study by the same researcher, the male to female ratio in Hirschsprung's disease was 2 : 1, and 61.6% of patients were diagnosed in the first 48 h of the neonatal period . In this study, the male to female ratio for Hirschsprung's disease was 3.54 : 1. The rates of mortality among cases with congenital diaphragmatic hernia were 66.7% in the first period and 26.3% in the second period of study. The rate of mortality was higher in the first period and similar in the second period, compared with a study carried out in Taiwan . The rate of colonic atresia was less than that of Nasir et al's  study. In our study, a meconium ileus was found in 2.3% of patients in the first period and in 2.4% of patients in the second period of study, which was less than Nasir et al's  study that showed 11.1%. In our study, in both periods, mortality rate from gastroschisis was higher than omphalocele, which differs from Salihu et al's study . In the past, omphalocele was clearly the most common type of newborn abdominal wall defect; however, the global incidence of gastroschisis seems to be increasing as noted from reports of some studies [10–12]. In our study, in both periods, male was the predominant sex in inguinal hernia and this is similar to other studies [13,14].
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