Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center

Abstract

Aim: To observe the incidence and outcome of pediatric surgical conditions in a tertiary
care center.
Method: A retrospective observational study was conducted at Motherhood Chaitanya
hospital between January, 2018 to December, 2021 and 118 patients requiring surgery
were enrolled during the time frame. These cases were divided into congenital and acquired
conditions. Incidence of various surgical conditions in different age groups has been
observed. The comparison was made as to which condition is predominantly common in
the center. Length of hospital stay was taken into consideration and time taken to initiate
enteral feeds and reach full feeds was studied in gastrointestinal (GI) cases. The outcome of
118 cases has been assessed in the form of discharge or death.
Results: In this study, a total of 118 patients were enrolled over the specified age time
frame from birth to 16 years. The majority of the cases were males and the male to female
ratio of 2.8:1. 32.2% of the cases were between 4 to 13 years, the age group most commonly
affected. 80 cases accounted for congenital anomalies with inguinal hernia being the most
common (18.75%). 31.5% were abscesses requiring drainage among acquired conditions.
50% of total cases were gastrointestinal cases with inguinal hernia having a maximum
incidence(25.4%). 32.2% of cases had a hospital stay of 24 to 48 hours. Time taken to
initiate feeds was 1.5 days in GI surgeries. Mortality of 2.5% has been observed in this
study.
Conclusion: Pediatric surgery conditions pose a major health and economic burden to the
community so they must be timely identified and treated.
Keywords: pediatric, neonatal, surgical conditions, outcome

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Introduction
There are surgical conditions in paediatrics which require
immediate attention and proper surgical care to prevent mortality
and morbidity.1,2 There are broad categories of pediatric surgical
conditions differing in socio-demography, age and time concerning
incidence. Low and middle-income countries pose a heavy burden of
pediatric surgical conditions, with about ve billion people not having
access to surgical care when needed and the pediatric age group is
equally affected.2–4 While the children are in the years of critical
development, pediatric surgical conditions have the risk of life-long
morbidity and mortality.5 Hence, children of a country represent a
population with critical and specic surgical needs which include
anaesthetic, perioperative, and postoperative capacity requirements.
WHO’s 63rd Health Assembly report says that 3,03,000 newborns die
within four weeks of life worldwide because of congenital anomalies.6
Apart from being the cause of death, these congenital conditions lead
to long-term disabilities affecting individuals, families, health system
and society.2 Diagnosis and management of congenital abnormalities
underwent a signicant breakthrough in the last 50 years.7,8 The truly
complex abnormalities are now treated with the success of up to 90%.7
Nowadays, congenital anomalies requiring surgery are diagnosed
antenatally so that delivery is conducted in specialized centres with a
neonatal surgical management team. If the accessibility and quality
of paediatric surgical care in lower and middle income countries are
improved, there is potential to substantially reduce mortality and
long- term disability among the children.7 ,8
Materials and methods
This retrospective observational study had been conducted at
Motherhood Chaitanya hospital, Chandigarh from January, 2018 to
December, 2021. The study was approved by an Institutional Ethics
Committee. A total of 118 patients whose age varies from birth to 16
years, and were under the care of a paediatric surgeon, were included
in the study after consent from their parents. Follow-up was done from
the time of admission to discharge. The information was recorded in
the prescribed set proforma. Demographic proles of the patients,
the age group and gender were recorded. Clinical presentation of the
patients, the condition is acquired or a congenital disorder, along with
the nal diagnosis details was recorded. The surgical conditions were
divided into congenital and acquired ones and the incidence of each
surgical condition was calculated. The division was made between
various age groups and incidence in the particular age group was seen.
Duration of their hospital stay and time to initiate enteral feeds post
operational mode were observed. Outcomes were assessed in the form
of discharge or death.
Statistical analysis
The data so collected was studied in Microsoft Excel software.
Data were analysed in the form of percentages. The median was
calculated for nominal variables using MS excel.
Results
All 118 patients enrolled from birth to 16 years of age during the
study period underwent surgery. Among the total number of patients,
73.7% were males and 26.3% were females.
The distribution of patients according to age groups has been
presented in Table 1. It had been observed that the largest number of
admissions were in the age group of 4-13 years (32.2%) followed by 1
J Pediatr Neonatal Care. 2023;13(2):87‒91. 87
©2023 Kaur et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and build upon your work non-commercially.
Retrospective pattern study of pediatric surgical
conditions outcome in a tertiary care center
Volume 13 Issue 2 - 2023
Gagandeep Kaur,1 Bijaylaxmi Behera,2 Ashish
Dharmik3
1Department of Neonatology and Pediatrics, Motherhood
Chaitanya Hospital, India
2Senior consultant Department of Neonatology and Pediatrics,
Motherhood Chaitanya Hospital, India
3Senior consultant Department of Pediatric Surgery,
Motherhood Chaitanya Hospital, India
Correspondence: Bijaylaxmi Behera, MD Pediatrics, DM
Neonatology, Senior consultant department of neonatology and
pediatrics, Motherhood Chaitanya Hospital, Chandigarh, India,
Tel 99853766057,
Email
Received: April 26, 2023 | Published: May 12, 2023
Abstract
Aim: To observe the incidence and outcome of pediatric surgical conditions in a tertiary
care center.
Method: A retrospective observational study was conducted at Motherhood Chaitanya
hospital between January, 2018 to December, 2021 and 118 patients requiring surgery
were enrolled during the time frame. These cases were divided into congenital and acquired
conditions. Incidence of various surgical conditions in different age groups has been
observed. The comparison was made as to which condition is predominantly common in
the center. Length of hospital stay was taken into consideration and time taken to initiate
enteral feeds and reach full feeds was studied in gastrointestinal (GI) cases. The outcome of
118 cases has been assessed in the form of discharge or death.
Results: In this study, a total of 118 patients were enrolled over the specied age time
frame from birth to 16 years. The majority of the cases were males and the male to female
ratio of 2.8:1. 32.2% of the cases were between 4 to 13 years, the age group most commonly
affected. 80 cases accounted for congenital anomalies with inguinal hernia being the most
common (18.75%). 31.5% were abscesses requiring drainage among acquired conditions.
50% of total cases were gastrointestinal cases with inguinal hernia having a maximum
incidence(25.4%). 32.2% of cases had a hospital stay of 24 to 48 hours. Time taken to
initiate feeds was 1.5 days in GI surgeries. Mortality of 2.5% has been observed in this
study.
Conclusion: Pediatric surgery conditions pose a major health and economic burden to the
community so they must be timely identied and treated.
Keywords: pediatric, neonatal, surgical conditions, outcomes
Journal of Pediatrics & Neonatal Care
Research Article Open Access

Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center 88
Copyright:
©2023 Kaur et al.
Citation: Kaur G, Behera B, Dharmik A. Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center. J Pediatr Neonatal Care.
2023;13(2):87‒91. DOI: 10.15406/jpnc.2023.13.00497
to 4 years (27.9%). Out of 118 patients, eighty (67.7%) had congenital
causes of paediatric surgery conditions and thirty-eight (32.2%) had
acquired causes.
Table 1 Distribution of patients according to age group (n=118)
Age Group Patients Percentage (%)
0 < age ≤ 28days 27 22.8
29 days ≤ age< one year 19 16.1
1≤ age < 4 years 33 27.9
4≤ age <13 years 38 32.2
13≤ age <16 years 1 0.8
Among the congenital conditions in Table 2 for eighty surgical
admissions, fteen cases (18.75%) were of inguinal hernia which was
the most common; the second most common being undescended testis
(11.25%). Anorectal malformation and anovestibular stula accounted
for 6.2% each of congenital causes. In the congenital group of cases,
about 3.75% were of pyloric stenosis, tongue tie, phimosis, Ileal/
Jejunal atresia, meningomyelocele and trachea oesophageal stula
each. Others included Sacrococcygeal teratoma (1.25%), eventration
of diaphragm (2.5%), posterior urethral valve (2.5%), cleft palate
(1.25%).
Table 2 Congenital causes with paediatric surgical admissions (n=80)
Diagnosis Admissions Percentage (%)
Tracheo oesophagal stula 3 3.75
Eventration of diaphragm 2 2.5
Hydrouretronephrosis 1 1.25
Congenital hernia of the cord 2 2.5
Posterior urethral valve 2 2.5
Hirschsprung disease 4 5
Anorectal malformation 5 6.2
Inguinal hernia 15 18.75
Undescended testis 9 11.25
Pyloric stenosis 3 3.75
Cleft palate 1 1.25
Hydrocele 4 5
Tongue tie 3 3.75
Rectal polyp 2 2.5
Hypospadias 6 7.5
Anovestibular stula 5 6.2
Meatal stenosis 1 1.25
Phimosis 3 3.75
Sacrococcygeal teratoma 1 1.25
Multicystic dysplastic kidney (MCDK) 1 1.25
Atresia Ileal/Jejunal 3 3.75
Meningomyelocele 3 3.75
Mesenteric cyst 1 1.25
The observations reported in Table 3 concluded that the acquired
causes of paediatric surgery admissions were 38 out of 118 (32.2%)
out of which twenty-one cases were infective, twelve (31.5%) were
abscess and nine (23.6%) of appendicitis. Other cases were related to
NEC/ perforation (15.7%), hydrocephalus (7.8%) and intussusception
(15.7%). There was only one case each of trauma and haemorrhoids
respectively.
Table 3 Acquired causes of paediatric surgery admissions: (n=38)
Diagnosis No. of admissions Percentage (%)
Necrotizing enterocolitis
(NEC)/ Perforation 6 15.7
Hydrocephalus 3 7.8
Intussusception 6 15.7
Abscess 12 31.5
Appendicitis 9 23.6
Haemorrhoids 1 2.6
Trauma 1 2.6
The distribution of causes of gastrointestinal cases has been
presented in Figure 1. Out of a total of 118 patients, half of the cases
i.e. 59 were gastrointestinal cases. 25.4% of the total GI cases were
of inguinal hernia which was the most commonly observed among GI
infections. The second most common gastrointestinal case was about
15.7%, were of appendicitis, whereas 10.1% of cases were each of
intussusception and NEC respectively. Anorectal malformation was
observed in ve cases (8.4%) cases. Hirsch sprung disease accounted
for 6.7% of cases among GI cases that required surgery. There were
three cases (5.08%) each of tracheoesophageal stula, ileal/ jejunal
atresia and pyloric stenosis respectively. Two cases (3.38%) of
congenital hernia of the cord were observed. Further, in one case
(1.6%) each mesenteric cyst, haemorrhoids and cleft palate were
operated on in the hospital.
Figure 1 Gastrointestinal causes of paediatric surgery cases (n=59).
It was concluded from Table 4 that 32.2% of the admitted cases
had a hospital stay of 24-48 hours followed by 27.1% of cases with a
stay of three to seven days. 22.8% of the cases had a stay of fewer than
twenty-four hours and only 5.08% of cases had more than fourteen
days of hospital stay.
Table 4 Duration of Hospital Stay
Duration in hours/days Number of patients Percentage (%)
Less than 24 hours 27 22.8
24 to 48 hours 38 32.2
3 to 7 days 32 27.1
8 to 14 days 15 12.7
More than 14 days 6 5.08
According to Table 5, the median time to initiate feeds in GI
surgeries was 1.5 days and the time to reach full feeds was 7.5 days
post-operation.

Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center 89
Copyright:
©2023 Kaur et al.
Citation: Kaur G, Behera B, Dharmik A. Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center. J Pediatr Neonatal Care.
2023;13(2):87‒91. DOI: 10.15406/jpnc.2023.13.00497
Table 5 Observations for a time of feeds in neonatal GI surgeries:
Time of feed Median (days)
Time for initiating feeds (Post op day) 1.5
Time to reach full feeds (Post op day) 7.5
The outcome of surgical cases shown in Figure 2 concluded that
nearly 97.4% of the admitted cases were discharged. Three deaths
were reported (2.5%) among paediatric surgery patients during the
frame of the study. Out of three deaths, two died due to septicaemia
and refractory shock after NEC perforation. One patient died due to
respiratory failure and septicaemia after being operated on for trachea
oesophagal stula.
Figure 2 Outcomes of surgical cases (n=118) in form of discharge/ death.
Discussion
Paediatric-surgical conditions are quite common in developing
countries, however inappropriate care results in life-long disabilities
and deaths.2 Primary care can only be fruitful if a timely referral is
done after stabilizing the patient for the effective surgical treatment.
Children have different surgical conditions and each may face specic
anaesthetic challenge.2
In the current study at Motherhood Chaitanya hospital, 118 patients
were enrolled in a time frame of three years and male to female ratio
was observed to be 2.8. This may be due to male preference for
treatment in a private hospital in India. Male predominance had been
reported in other studies carried out in Somaliland and Uganda.9,10
This may be due to a large number of patients (14.4%) admitted
with male genitourinary problems. Similar ndings were reported by
Doumi et al.11 as well.
In this presented scenario, 27 cases out of 118 surgical cases were
neonatal surgeries (22.8%). A study from the government hospital
in Kathmandu, Nepal showed 205 neonatal surgeries in two years.12
Studies from India reported nearly a thousand neonatal surgeries in
three years and Rwanda showed nearly seventy ve such surgeries in
one year.13,14
In this study, nearly 27.9% surgical cases belong to the age group
between one to four years. In comparison to a study done in Cairo in
which age ranged between a few hours and twelve years with a mean
age of 11.7 months.15 has been reported.
Further, it had been observed that the 67.7% of surgical conditions
were congenital. Maximum cases of inguinal hernia (18.75%) were
reported followed by 11.25% of undescended testis. Doumi et al.11
also concluded that congenital anomalies accounted for 40% of the
total surgical cases with maximum cases of inguinal hernia. Fazle
Mubarak Bari et al.16 carried out a study in Dhaka where gastric
intestinal tract (GIT) had been reported for a nearly 27% of the
cases, followed by the nervous system. Taksande et al.17 concluded
that cardiovascular malformations were most common. In a study
by Pathak S. et al.18, congenital anomalies were the commonest
causes of admission, amounting to 65.35% of considered cases.
Arushi Agarwal et al.19 found that the most common anomalies were
neural tube defects (NTD) of about 24.3%, followed by anorectal
malformation (ARM) in 20.7% of cases, and then tetralogy of Fallot
(TOF) in 20% cases. Further, it had been reported that males were
affected more than females. Among the acquired cases 31.5% of
surgical cases were reported with an abscess in our centre followed
by 23.6% cases of appendicitis. Abscesses need incision and drainage
and minor procedures which involve minimal hospital stay are mostly
completed in our centres. In addition, appendicitis is easily diagnosed
and is operated on laparoscopically in the majority of cases. In the
Yirgalem study by Tekle TT, et al.20, the leading cause of admission
was found to be intussusceptions in 14.1% of the considered cases.20
The difference in the two studies was due to the different capacities of
hospitals for service provisions. A similar nding following our study
was observed in other studies carried out in Africa which showed
among skin and soft tissue injury abscesses, pyomyositis was more
common.2
Only one case of trauma was operated on in our centre due to a lack
of availability of neurosurgeons, as most trauma cases involve head
injuries. There was another observation done among gastrointestinal
cases. According to our study, 25.4% of GI cases were of inguinal
hernia followed by appendicitis, intussusception, NEC and anorectal
malformations. About 40.9% of cases with gastrointestinal causes
were the most common cause of pediatric surgical admission. The
commonest being inguinal hernia in 18.11% of cases in a study
by Pathak S, et al.18 A study from Ethiopia showed that among
gastrointestinal conditions appendicitis was the most common cause
followed by infantile pyloric stenosis.21 Derbew et al.22 also had
similar ndings with gastrointestinal cases being most common with
appendicitis as a leading cause of the surgical condition.
In the presented study maximum cases of about 32.2% had hospital
stays between 24-48 hours followed by nearly 27.1% cases with a
hospital stay of 3-7 days. In a study by Temesgen Firomsa., et al.24
the average length of hospital stay is 4.3 days.24 Also study by Peiffer
et al.25 to determine predictors of poor postoperative outcome length of
hospital stay was about 3.0 days. J.S. Karpelowsky et al.26 concluded
that the median length of hospital stay was 4 days (interquartile
range, 2-14 days) in HIV-infected children undergoing surgery. In
most of the studies, the most common surgeries are inguinal hernia or
small GI surgeries which are discharged within 2-3 days. Prolonged
hospital stays have seen only cases with complications and mortality.
GI surgeries in neonates were considered in our study and the
median time to initiate feeds were 1.5 days and the time to reach
maximum feeds were 7.5 days to post-operation. In various studies,
Early enteral feeding (EEN), was dened as ranging from eight hours
to ve days. The earliest was Ekingen,27 whereas feeding in the EEN
group was started between eight and twenty hours post-operatively,
with a mean of twelve hours. Davila -Perez’s28 study stated EEN as
any time before postoperative day 5, with a minimum interval of 24
hours. Jensen29 was the only gastrostomy study which reported time to
full enteral feeding. In laparoscopic the median time to reach full feeds
was 17.4 hours in comparison to 58.3 hours in open surgeries. Davila-
Perez’s28 and Yadav30 studied EEN following intestinal anastomosis

Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center 90
Copyright:
©2023 Kaur et al.
Citation: Kaur G, Behera B, Dharmik A. Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center. J Pediatr Neonatal Care.
2023;13(2):87‒91. DOI: 10.15406/jpnc.2023.13.00497
both showed a signicantly lesser time to reach full feeds of the order
of 62.3 hours in comparison to 196 hours in the EEN group.
In the presented study, 97.4% of patients were discharged with
mortality rates of 2.5% and all patients died of GI surgery complicated
with sepsis. 1.7% of deaths occurred in Ghana in the study presented
by Peiffer et al.25 Sowande et al.31 had reported that sepsis was the
most common complication and resulted in the worst outcome with a
mortality rate of 53.6%. Pignaton et al.32 related to age and mortality
and found that patients of age less than one year have higher rates of
mortality in comparison to higher age groups.
Hospital admission data may be quite helpful to assess the
epidemiology of a disease within population. The results of the
presented study help us to understand the surgical conditions affecting
children in the community. Considerable progress can be made if we
realise the aws in identifying and curing these paediatric surgical
conditions and making it a priority to include them in national health
programs.23 The challenge is to deliver effective paediatric surgical
facilities in the form of a paediatric surgeon, and experienced
anaesthetist and provide sufcient resources to bear the brunt of these
surgical diseases.
Limitations
This study was conducted on the surgical admissions in a tertiary
care hospital and the true burden of paediatric surgery problems in the
community could not be assessed. It needs a large community-based
study to estimate the burden of acquired and congenital paediatric
surgical problems more accurately.
Acknowledgements
None
Funding
None
Conicts of interest
No conict of interest exists.
References
1. Hackam DJ, Grikscheit T, Wang K, et al. Principles of Surgery. 10th
ed. Introduction to pediatric surgery, global burden of surgery. chap;
39:1597–1600 & chap;49;1955–1978.
2. Bickler SW, Rode H. Surgical services for children in developing coun-
tries. Bull World Health Organ. 2002;80(10):829–835.
3. Butler EK, Tran TM, Fuller AT, et al. Quantifying the paediatric surgical
need in Uganda: Results of a nationwide cross-sectional, household sur-
vey. Pediatr Surg Int. 2016;32(11):1075–1085.
4. Fuller AT, Haglund MM, Lim S, et al. Pediatric Neurosurgical Outcomes
Following a Neurosurgery Health System Intervention at Mulago Hospi-
tal in Uganda. World Neurosurg. 2016;95:309–314.
5. Ozgediz D, Poenaru D. The burden of pediatric surgical conditions
in low and middle-income countries: A call to action. J Pediatr Surg.
2012;47(12):2305–2311.
6. Boyle B, Addor MC, Arriola L, et al. Estimating global burden of disea-
se due to a congenital anomaly: an analysis of European data. Arch Dis
Child Fetal Neonatal Ed. 2018;103(1):F22–F28.
7. Bianchi F, Bianca S, Barone C, et al. Updating of the prevalence of
congenital anomalies among resident births in the municipality of Gela
Southern Italy. Epidemiol Prev. 2014;38(3–4):219–226.
8. Farmer D, Sitkin N, Lofberg K, et al. Chapter 8: Surgical Interventions
for Congenital anomalies. In: Essential surgery: Disease control priori-
ties. Volume 1. 3rd ed., 2012.
9. Cheung M, Kakembo N, Rizgar N, et al. Epidemiology and mortality of
pediatric surgical conditions: insights from a tertiary centre in Uganda.
Paediatr Surg Int. 2019;35(11):1279–1289. |
10. Concepcion T, Mohamed M, Dahir S, et al. Prevalence of pediatric surgi-
cal conditions across Somaliland. JAMA Netw Open. 201;2(1):e186857.
11. Doumi EA. Perspectives on Pediatric Surgical Admissions at El Obeid
Hospital, Western Sudan, Sudan. JMS. 2010;5(1):35–39.
12. Thapa B, Basnet A. Patterns and outcome of neonatal intestinal obstruc-
tion in Kanti Children’s Hospital. J Nepal Pediatric Soc. 202;40(2):120–
124.
13. Bhosale M, Soni V. Audit of paediatric surgical services in a tertiary care
hospital in Maharashtra, India. J Med Sci Clin Res. 2019;7(7):415–424.
14. Abahuje E, Uyisabye I, Ssebuufu R. Epidemiology of paediatric surgery
in Rwanda: A one-year review. Rwanda Med J. 2016;73(1):11–16.
15. Ahmed E, Ahmed F, Magdy El B, et al. Pattern and incidence of pedia-
tric surgical emergencies in Cairo university children’s hospital, Giza,
Egypt. Master (MSc) Thesis. 2001.
16. Fazle C Mubarak B. Spectrum of congenital anomalies among children
attending the pediatric departments of Dhaka medical college hospital.
IOSR Journal of Dental and Medical Sciences. 2014;13(2):20–46.
17. Taksande A, Vilhekar K, Chaturvedi P, et al. Congenital malformations
at birth in Central India: a rural medical college hospital-based data.
Indian J Hum Genet. 2010;16(3):159–163.
18. Pathak S, Mhapsekar R, Gupta N, et al. Clinical prole and outcome of
pediatric surgical patients in a rural tertiary centre. International Journal
of Contemporary Pediatrics. 2021;8(11):1770–1775.
19. Agarwal A, Rattan KN. Dhiman A, et al. Spectrum of congenital ano-
malies among surgical patients at a tertiary care centre over 4 Years.
International journal of paediatrics. 2017:4174573.
20. Tekle TT, Mollalegne TM. Pattern of pediatric surgical admission in Yir-
galem Hospital, Southern Ethiopia. J Vasc Med Surg. 2015;4:239.
21. Ketema T, Abeya SG, Abdela K, et al. Pediatric surgical admissions
and their outcomes at Adama hospital medical college: a facility-based
cross-sectional study. Am J Pediatr. 2017;3(4):23–27.
22. Derebew M, Ahmed E. Pattern of paediatrics surgical condition at BLH,
AAU Medical Faculty. Ethiop Med J. 2006;44(4):331–338.
23. Paterson N, Waterhouse P. Risk in pediatric anaesthesia. Paediatr
Anaesth. 2011;21(8):848–857.
24. Firomsa T, Teferra M, Tadesse A. Trends and outcomes of emergency
pediatric surgical admissions from a tertiary hospital in Ethiopia. Ethiop
J Health Sci. 2018;28(3):251–258
25. Peiffer S, Ssentongo AE, Keeney L, et al. Predictors of poor posto-
perative outcomes in pediatric surgery patients in rural Ghana. BMC
Surg. 2020;20(11):211.
26. Karpelowsky JS, Zar HJ, Bogerijen G, et al. Predictors of postoperative
complications in HIV-infected children undergoing surgery. J Pediatr
Surg. 2011;46(4):674–678.
27. Ekingen G, Ceran C, Guvenc B, et al. Early enteral feeding in newborn
surgical patients. Nutrition. 2005;21(2):142–146.
28. Davila-Perez R, Bracho-Blanchet E, Galindo-Rocha F, et al. Early fee-
ding vs 5-Day fasting after distal elective bowel anastomoses in chil-
dren. A randomized controlled trial. Surg Sci. 2013;4(1):45–48.
29. Jensen A, Renaud E, Drucker N, et al. Why wait: early enteral fee-
ding after pediatric gastrostomy tube placement. J Pediatr Surg.
2018;53(4):656–660.

Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center 91
Copyright:
©2023 Kaur et al.
Citation: Kaur G, Behera B, Dharmik A. Retrospective pattern study of pediatric surgical conditions outcome in a tertiary care center. J Pediatr Neonatal Care.
2023;13(2):87‒91. DOI: 10.15406/jpnc.2023.13.00497
30. Yadav P, Choudhury R, Grover J, et al. Early feeding in pediatric patien-
ts following stoma closure in a resource-limited environment. J Pediatr
Surg. 2013;48(5):977–982.
31. Sowande OA, Ogundoyin OO, Adejuyigbe O. Pattern and factors
affecting management outcome of neonatal emergency surgery in Ile-
Ife, Nigeria. Surgical Prac. 2007;11(3):71–75.
32. Pignaton W, Braz JRC, Kusano PS, et al. Perioperative and anaesthesia-
related mortality: An 8-year observational survey from a tertiary
teaching hospital. Medicine. 2016;95(2):e2208.