P0256 - Exploring prognostic factors for a duodenal and intestinal atresia cohort in Haiti.

Purpose: In Haiti the diagnosis and management of congenital anomalies is challenging due to limited diagnostic capabilities, pre-operative resources and access to pediatric surgeons. Currently, no published data on patient characteristic and outcomes for duodenal and intestinal atresia exist in Haiti. The goal of this abstract is to describe a cohort of duodenal and intestinal atresia patients with regards to patient characteristics and outcomes at the only pediatric hospital in Port Au-Prince, Haiti.

Methods: The pediatric surgery team at the only pediatric hospital in Port Au Prince, Haiti performed a retrospective study of all duodenal and intestinal atresia operations performed between 2015-2019. Data collected included demographic information, driving distance from the hospital, pre-operative vitals, imaging and laboratory workup, type of operation, post-operative morbidity and mortality. Low birthweight was defined as weighing less than 2500 g, post-operative mortality was defined as a death within 30 days of the operation, and sepsis was defined as leukocytosis >11,000 with a fever greater than 37.5 o C.

Results: 21 patients underwent surgery for duodenal or intestinal atresia. The median age at presentation was 6 [IQR 2; 9] days and 57% of patients were female. 71% of patients’ families lived within a 2-hour driving distance. While the total number of patients with a prenatal ultrasound was unknown 4 (19%) of patients had a prenatal ultrasound concerning for atresia, and 10 (50%) patients had another diagnosed congenital anomaly. The median time to operation from birth was 16 days and 12 (57.14%) were septic prior to their operation, and 5 (23.8%) had access to total parenteral nutrition (TPN). Of the 21 patients, 6 (28.5%) had duodenal atresia, 9 (42.85%) had jejunal atresia, 4 (19.04%) had jejunoileal, atresia, 1 (4.76%) had ileal atresia and 1 (4.76%) had colonic atresia. Post-operative complications from this study cohort were: severe anemia (24%), septic shock (19%), thrombopenia (19%), hyperbilirubinemia with encephalopathy (9%), ileus (9%), bowel obstruction (5%) severe malnutrition (5%) and anastomotic leak (5%). Postoperative mortality rate at 30 days was 33.33%. Low birthweight, location of atresia, and pre-operative sepsis were associated with an increased risk of postoperative mortality (p<0.05).

Conclusion: This is the first study from Haiti exploring patient characteristics and outcomes for a cohort of duodenal and intestinal atresia patients. We found that the majority of patients did not receive pre-operative nutrition with TPN, and that post-operative mortality for this condition remains high at 33%. This study highlights the need for improved access to resources for pediatric congenital anomalies in Haiti including but not limited to improved prenatal diagnostics and preoperative nutrition in order to lower mortality rates for this vulnerable patient population.