Épidémiologie des urgences chirurgicales néonatales à Ouagadougou

RésuméObjectifDéterminer la fréquence des urgences chirurgicales néonatales, en faire ressortir les principales causes et les difficultés de prise en charge.Patients et méthodesIl s’est agi d’une étude prospective descriptive sur une année. Cent deux cas ont été colligés. Nous avons étudié l’âge à l’admission, les pathologies rencontrées, les malformations associées, les modalités de prise en charge et le pronostic.RésultatsLes affections en cause intéressaient le tube digestif (63,7 %), la paroi antérieure de l’abdomen (24,5 %), la traumatologie (6,7 %) et les tumeurs (2 %) avec un sex-ratio de 1,55. La mortalité globale a été de 30,3 % et la mortalité postopératoire de 32,35 %. Le retard à la consultation, la prématurité, les malformations associées et le faible poids de naissance constituaient les principaux facteurs de risque.ConclusionLes urgences chirurgicales néonatales regroupent des affections qui exigent une prise en charge immédiate et adéquate. La formation continue des agents de santé à tous les niveaux sur le dépistage des urgences néonatales, et l’équipement de nos structures sanitaires constituent une nécessité et un impératif absolu si l’on veut améliorer la prise en charge et diminuer le taux de mortalité.

SummaryObjectiveThe purpose of this study was to determine the rate of neonatal surgery emergencies and to highlight the main causes and difficulties related to better handling of these emergencies.Patients and methodsWe conducted a 1-year descriptive prospective study from September 2009 to September 2010 based on 102 cases collected. At admission, we studied the patients’ age, the pathologies encountered, the related malformations, the terms for better management, and prognosis.FindingsIn 1 year, we registered 102 cases of neonatal surgical emergencies affecting the digestive tract (63.7%), the anterior side of the abdomen (24.5%), trauma (6.7%), and tumors (2%). Males comprised 60.8% of the cases. The sex-ratio was 1.55. The frequency of such cases was 3.94%. The average age of patients was 5 days with the 0- to 5-day-old age group presenting most frequently. The average hospitalization lasted 2.75 days and the admission method was the reference in 75.5%. Congenital pathology accounted for 95.5% of cases with anorectal malformations (ARM) (35; 95%) and omphaloceles (28.1%). Hirschsprung disease was the main cause of bowel obstruction other than ARM (50%). The average time to surgery was about 2.54 days. The overall mortality of neonatal surgical emergencies was 30.3% and postoperative mortality 32.35%. The late consultation, poverty, a shortage of qualified staff, prematurity, low birth weight, congenital disease, and related malformations were the leading factors of a poor prognosis. Acquisition of effective technical means, staff training, measures to combat poverty, and better prenatal care would improve the management of neonatal surgical emergencies.ConclusionNeonatal surgical emergencies include conditions that require immediate and adequate support. The continuous training of healthcare workers at all levels in the detection of neonatal emergencies and equipping healthcare facilities are an absolute necessity to provide better management and reduce the mortality rate.