The outcomes of specific surgically correctable congenital gastro-intestinal malformations at a tertiary level neonatal intensive care unit in South Africa


  • Dr Ilhaam Abrahams Stellenbosch University, Cape Town, South Africa
  • Prof Lizelle Van Wyk Stellenbosch University, Cape Town, South Africa
  • Dr Corne De Vos Stellenbosch University, Cape Town, South Africa



Congenital gastro-intestinal malformations, Surgery, Low-middle income, Neonates, Outcomes


Background: The outcome of neonates with congenital surgically correctable gastro-intestinal (GIT) malformations is poorly described in low middle income countries.

Methods: A 5-year retrospective descriptive analysis of neonates admitted to a tertiary level neonatal intensive care unit (NICU), with congenital, surgically correctable GIT malformations, was performed. The primary outcome was the 30-day postoperative mortality as well as survival to 1 year. Secondary outcomes included patient demographics, clinical presentation as well as the burden of disease in our study population.

Results: Eighty-four neonates met study criteria. The mean gestational age was 35 weeks (SD 3.19) and birthweight 2518g (SD 789.3). The most common congenital malformations were intestinal atresia (39%) followed by omphaloceles (21%). Associated systemic malformations were common (39%). The majority of neonates (88%) underwent surgery at a median age of 2 days (IQR 1.5-5). Ventilation was required in 19% of neonates preoperatively and 65% postoperatively. Full feeds were achieved at a median age of 13 days (IQR 9-18) after surgery. The 30 day-postoperative survival rate was 97% with a survival to discharge or transfer of 86%. Data for one year survival was available for 80% of neonates with a one-year survival rate of 75%.

Conclusion: The 30-day postoperative survival was high in neonates with congenital, surgically correctable GIT malformations. Outcomes and burden on the healthcare system was dependent on the type of lesion. With early diagnosis and referral to a tertiary centre, good outcomes can be achieved. Neonates with congenital GIT malformations should have long term follow up to monitor growth and neurodevelopment as well as to address the high mortality post discharge.


Download data is not yet available.


Metrics Loading ...

Author Biographies

Dr Ilhaam Abrahams, Stellenbosch University, Cape Town, South Africa

Division of Neonatology, Dept. Paediatrics & Child Health,

Prof Lizelle Van Wyk, Stellenbosch University, Cape Town, South Africa

Division of Neonatology, Dept. Paediatrics & Child Health,

Dr Corne De Vos, Stellenbosch University, Cape Town, South Africa

Division of Paediatric Surgery,


Wang H, Bhutta ZA, Coates MM, Coggeshall M, Dandona L, Diallo K, et al. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet [Internet]. 2016;388(10053):1725–74. Available from:

Paul VK, Singh M. Regionalized perinatal care in developing countries. Semin Neonatol. 2004;9(2):117–24.

Agarwal A, Rattan KN, Dhiman A, Rattan A. Spectrum of Congenital Anomalies among Surgical Patients at a Tertiary Care Centre over 4 Years. Int J Pediatr. 2017;2017:4174573–4.

Wright NJ. Management and outcomes of gastrointestinal congenital anomalies in low, middle and high income countries: protocol for a multicentre, international, prospective cohort study. Wright N, Leather A, Sevdalis N, Ade-Ajayi N, Ademuyiwa A, Ameh E, et al., editors. BMJ Open [Internet]. 2019;9(8). Available from: (Accessed 02/10/2019)

Paoletti M, Raffler G, Gaffi MS, Antounians L, Lauriti G, Zani A. Prevalence and risk factors for congenital diaphragmatic hernia: A global view. J Pediatr Surg. 2020;55(11):2297–307.

Mayer MMM, Velaphi SC. Incidence, types and outcomes of congenital anomalies in babies born at a public, tertiary hospital in South Africa. SAJCH. 2021;15(4):193–7.

White R. Surgical emergencies. In: Roberts B, editor. Manual of clinical problems in Paediatrics. 5th ed. Lippincott Williams and Wilkins; 2000. p. 275–81.

Morris G, Kennedy A, Cochran W. Small Bowel Congenital Anomalies: a Review and Update. Curr Gastroenterol Rep [Internet]. 2016 Mar;18(4):16. Available from: (Accessed 02/10/2019)

Schindewolf E, Moldenhauer JS. Genetic counseling for fetal gastrointestinal anomalies. Curr Opin Obstet Gynecol. 2020;32(2):134–9.

Desoky S, Kylat R, Udayasankar U, Gilbertson-Dahdal D. Managing neonatal bowel obstruction: clinical perspectives. Res reports Neonatol. 2018;8:19–32.

Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT. Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet. 2015;385(9983):2209–19.

Ekenze SO, Ajuzieogu OV, Nwomeh BC. Challenges of management and outcome of neonatal surgery in Africa: a systematic review. Pediatr Surg Int [Internet]. 2016 Mar;32(3):291–9. Available from:

Klein MD. Chapter 75 - Congenital Defects of the Abdominal Wall. In: Pediatric Surgery. 2012. p. 973–84.

Ameh EA, Seyi-Olajide JO, Sholadoye TT. Neonatal surgical care: a review of the burden, progress and challenges in sub-Saharan Africa. Paediatr Int Child Health [Internet]. 2015;35(3):243–51. Available from:

WHO. Birth defects surveillance: A manual for programme managers, 2nd Edition [Internet]. WHO, CDC IC for BD, editor. Geneva; 2020. 1–283 p. Available from: (accessed 21/02/22)

de Vos C, van Wyk L, Sidler D GP. The 30-day outcome of neonates operated for esophageal atresia. J Neonatal Surg. 2022;11:12.

Van Eck A. A retrospective review of the outcomes of gastroschisis at a tertiary hospital in Cape Town. [Cape Town]: Master’s Thesis, Stellenbosch University; 2017.

Ngcobo Q, de Vos C. Risk factors for sepsis in neonates treated with gastroschisis at a tertiary hospital. Stellenbosch University; 2023.

Kaur N, Pamnani S, Kaur B. Role of ultrasound in diagnosis of fetal congenital abdominal anomalies: One year prospective study. Int J Med Res Rev [Internet]. 2017;5(7):649–56. Available from:

Stefos TI, Plachouras NI, Sotiriadis A, Papadimitriou D, Almoussa N, Navrozoglou I, et al. Routine obstetrical ultrasound at 18-22 weeks: our experience on 7,236 fetuses. J Matern Fetal Med. 1999;82:64–9.

Siyotula T, Arnold M. An analysis of neonatal mortality following gastrointestinal and/or abdominal surgery in a tertiary hospital in South Africa. Pediatr Surg Int. 2022;38(5):721–9.

Wright NJ, Leather AJM, Ade-Ajayi N, Sevdalis N, Davies J, Poenaru D, et al. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. Lancet [Internet]. 2021;398(10297):325–39. Available from:

Leather AJM, Ngwenya S, Jones B, Shu Q, Pasqua N, Outani O, et al. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. Lancet (British Ed. 2021;398(10297):325–39.

Adejuyigbe O, Abubakar AM, Sowande OA, et al. Experience with anorectal malformations in Ile-Ife, Nigeria. Pediatr Surg Int. 2004;20(11):855–8.

Mohammed M, Amezene T, Tamirat M. Intestinal Obstruction in Early Neonatal Period: A 3-Year Review Of Admitted Cases from a Tertiary Hospital in Ethiopia. Ethiop J Health Sci. 2017;27(4):393–400.

Hasan MS, Islam N, Mitul AR. Neonatal Surgical Morbidity and Mortality at a Single Tertiary Center in a Low- and Middle-Income Country: A Retrospective Study of Clinical Outcomes. Front Surg [Internet]. 2022;9. Available from:

Levitt MA, Pena A. Anorectal malformations. Orphanet J Rare Dis. 2007;2(1):33.

Shakeel F, Newkirk M, Sellers A, Shores DR. Postoperative Feeding Guidelines Improve Outcomes in Surgical Infants. JPEN J Parenter Enteral Nutr. 2020;44(6):1047–56.

Penman G, Tavener K, Hickey A. Neonatal feeding: care and outcomes following gastrointestinal surgery. Infant J. 2017;13(2):61–4.

Ballot DE, Bandini R, Nana T, Bosman N, Thomas T, Davies VA, et al. A review of multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa. BMC Pediatr. 2019;19(1):320–9.

Nkwanyana NM, Singh R, Mzimela BW. Clinical outcome of neonates with Carbapenem-resistant Enterobacteriaceae infections at the King Edward VIII Hospital’s neonatal unit, Durban, South Africa. South African J Infect Dis. 2021;36(1):e1–6.

Thomas R, Ondongo-Ezhet C, Motsoaledi N, Sharland M, Clements M, Velaphi S. Incidence and All-Cause Mortality Rates in Neonates Infected With Carbapenem Resistant Organisms. Front Trop Dis [Internet]. 2022;3. Available from: (accessed 20 June 2022)

Folgori TL, Bielicki TJ, Heath TP, Sharland TM. Antimicrobial-resistant Gram-negative infections in neonates: burden of disease and challenges in treatment. Curr Opin Infect Dis. 2017;30(3):281–8.

Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet (British Ed. 2017;390(10104):1770–80.

Mpody C, Shepherd EG, Thakkar RK, Dairo OO, Tobias JD, Nafiu OO. Synergistic effects of sepsis and prematurity on neonatal postoperative mortality. Br J Anaesth BJA. 2020;125(6):1056–63.

Shetty S, Kennea N, Desai P, Giuliani S, Richards J. Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England. Ann R Coll Surg Engl. 2016;98(1):56–60.

Gasparella P, Singer G, Kienesberger B, Arneitz C, Fullop G, Castelleni C, et al. The Financial Burden of Surgery for Congenital Malformations—The Austrian Perspective. Int J Environ Res Public Health [Internet]. 2021;18(11166):11166-. Available from: (accessed 28/06/2022)

Lawal TA. Overview of Anorectal Malformations in Africa. Front Surg. 2019;6.

Collaboration PAR. Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study. Wright NJ, Smith ER, Bisquera A, John-Chukwuemeka AL, Lawal TA, Seyi-Olajide J, et al., editors. BMJ Glob Heal [Internet]. 2021;6(9). Available from:

Sholadoye TT, Mshelbwala PM, Ameh EA. Presentation and outcome of treatment of jejunoileal atresia in Nigeria. African J Paediatr Surg. 2018;15(2):84–7.

Du Preez H BE. Findings from the University of the Free State Yields New Data on Gastroenterology (The Profile and Outcome of Small Bowel Atresia At Universitas Academic Hospital). South African J Surg. 2023;61(1).

Ţarcă E, Cojocaru E, Trandafir LM, Luca AC, Tiutiucă RC, Butnariu LI, et al. Current Challenges in the Treatment of the Omphalocele—Experience of a Tertiary Center from Romania. J Clin Med. 2022;11(19):5711.

Rode H, Millar AJW. Our surgical heritage: the role of the Department of Paediatric Surgery in the development of paediatric surgery in Cape Town, in Africa, and around the world. South African Med J. 2012;102(6):409–11.

Okoye MT, Ameh EA, Kushner AL, et al. A Pilot Survey of Pediatric Surgical Capacity in West Africa. World J Surg. 2015;39(3):669–76.

Burgos CM, Frenckner B. Addressing the Hidden mortality in CDH: A population-based study. J Pediatr Surg. 2016;52(4):522–5.

Roorda D, Königs M, Eeftinck Schattenkerk L, van der Steeg L, van Heurn E, Oosterlaan J. Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2021;106(6):635–42.

Stolwijk LJ, Lemmers PMA, Harmsen M, Groenendaal F, de Vries LS, van der Zee DC, et al. Neurodevelopmental Outcomes After Neonatal Surgery for Major Noncardiac Anomalies. Pediatrics [Internet]. 2016;137(2):e20151728–e20151728. Available from: (Accessed 07/10/2019)

Bevilacqua F, Ravà L, Valfrè L, Braguglia A, Zaccara A, Gentile S, et al. Factors affecting short-term neurodevelopmental outcome in children operated on for major congenital anomalies. J Pediatr Surg. 2015;50(7):1125–9.




How to Cite

Abrahams I, Van Wyk L, De Vos C. The outcomes of specific surgically correctable congenital gastro-intestinal malformations at a tertiary level neonatal intensive care unit in South Africa. J Neonatal Surg [Internet]. 2023Dec.31 [cited 2024Jul.21];13:8. Available from:



Original Article