Intestinal atresia is among the most common reasons for intestinal blockage in newborns, occurring in approximately 0.4 to 3.1 cases per 10,000 live births (1). Despite advancements in reducing short-term complications associated with intestinal atresia, these conditions still pose risks of postoperative complications, long-term morbidities, and mortality (2). The long-term complications in these infants mainly arise from intestinal dysfunction and extended dependence on parenteral nutrition (PN) (3). The extended use of central lines for PN places these patients at risk of sepsis and bacterial overgrowth in the compromised intestine. Moreover, sustained dependence on PN correlates with cholestasis and liver disorders (4, 5). Apart from complications tied to intestinal resection during surgical correction, motility and functional disturbances in the remaining intestine contribute to the emergence of complications (6). This study explores the complications and outcomes of neonates with intestinal atresia to facilitate preventive measures and diminish future occurrences.

  

Discussion

Recent advancements in surgical methods, the increased use of intravenous nutrition, and lower neonatal mortality rates related to intestinal atresia have highlighted the importance of long-term complications in these patients. The survival of individuals with short bowel syndrome, supported by intravenous nutrition, has led to a rise in complications like sepsis and liver failure (1). This study, conducted to explore the complications and outcomes of neonates with gastrointestinal atresia hospitalized at Shahid Sadoughi Hospital in Yazd between 2016 and 2021, revealed a reported prevalence of duodenal atresia at 39%, aligning with findings from other studies citing duodenal atresia prevalence between 30% and 50% (9, 10). Some research indicates a concurrent occurrence of cardiac anomalies in about 20-25% of neonates with duodenal atresia (10).
In this study, 47.8% of patients with duodenal atresia exhibited a coexisting cardiac anomaly. Discrepancies may arise from sample size and study location.
Clinical symptoms in neonates with duodenal atresia usually appear within the first one or two days after birth, presenting as obstructive signs such as persistent vomiting, bilious vomiting, gastric distension, or difficulties with feeding (11). Here, the average onset age of clinical symptoms in duodenal atresia was 2.21 days. While the long-term prognosis for duodenal atresia is generally favorable, complications and mortality often stem from associated anomalies and short bowel syndrome necessitating extended total parenteral nutrition (6). In this study, approximately 17% of neonates with duodenal atresia died.
The incidence of jejunoileal atresia in Europe ranges from 0.3 to 1.1 per 10,000 births (12). In this study, jejunal and ileal atresia incidences were 28.8% and 8.5%, respectively. The male-to-female ratio in jejunoileal atresia studies typically falls around 1.2 (13-15). Conversely, our study observed 10 male and 23 female patients affected by jejunal and ileal atresias, a deviation from reported ratios.
The mortality rate in the group with jejunal and ileal atresia was 12.1% (4 out of 33 patients), aligning with rates ranging from 10% to 16% in most studies (2) but occasionally varying from 3.5% to 30% in limited research (16, 17).
Short bowel syndrome affected 15.3% of patients in this study, with 10.01% in the jejunal and ileal atresia groups, akin to findings in other studies (18).
Colonic atresia, more prevalent in males, typically manifests with distal intestinal obstruction symptoms within the initial two days of life (19-21). In our study, the mean age at colonic atresia diagnosis was 1.52 ± 2.33 days.
A Netherlands study on 114 jejunal atresia cases reported 26% requiring re-enterostomy, 15% developing short bowel syndrome, 47% needing long-term parenteral nutrition via central venous lines, and an approximately 11% mortality rate (2). In our study, the mortality rate for patients with jejunal atresia was 5.9%, lower than the study above, while rates of short bowel syndrome and central venous line dependency were comparable.
This study faced limitations including a small sample size and data collection from a single center, limiting generalizability. Future multi-center studies with larger samples could offer more comprehensive insights.

 

Conclusion

Early identification of associated anomalies and advancements in surgical and critical care have enhanced survival in neonates with intestinal atresia. However, short bowel syndrome persists as a primary long-term complication, leading to extended hospital stays, sepsis, and mortality.

 

Declarations

Acknowledgements

The researchers express their gratitude to the study participants, their families, and all personnel at Shahid Sadoughi Hospital.

 

Ethical Considerations

The research plan of this study was approved by the Research Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, with code: IR.SSU.MEDICINE.REC.1400.244.

 

Authors' Contributions

SR. M and M.N S conceptualized and designed the study. MH.L, M.A B and A. A provided the data. R. E. conducted the statistical analysis and data interpretation and wrote and revised the manuscript. All authors have read and approved the final version of the manuscript. The final manuscript was read and approved by all of the authors.

 

Conflicts of Interest

The authors declare that there are no conflicts of interest.

 

Fund or Financial Support

This research received no specific grant from any funding agency in the public, commercial, or not for profit sector.

 

Using Artificial Intelligence Tools (AI Tools)

The authors were not utilized AI Tools.