Covid-19 pandemic and neonatal surgical outcomes: Lessons learned from a resource-challenged setting

Abstract

Introduction: The management of neonatal surgical diseases is complex, especially in Low- and Middle-Income Countries (LMICs), where limited resources and high rates of sepsis contribute to poorer outcomes. The COVID-19 pandemic further impacted healthcare systems globally, with many elective surgeries postponed and resources reallocated to critically ill patients. This study aimed to assess the impact of COVID-19 on neonatal surgical admissions, mortality, and sepsis rates in a tertiary hospital in Northern India.

Methods: This retrospective, observational study analysed admission data from the Neonatal Surgical Intensive Care Unit (NSICU) over two periods: pre-COVID (March 2019 - February 2020) and during COVID (March 2020 - February 2021). Data included patient demographics, diagnoses, admission-to-surgery intervals, and outcomes. Interrupted time series analysis and statistical comparisons were performed, with p<0.05 considered significant.

Results: There was an 18% decline in annual admissions during the COVID period, with a significant delay in surgery due to mandatory pre-operative COVID testing. Despite fewer admissions, 30-day mortality and sepsis rates significantly decreased (mortality from 29% to 22%, p=0.002), potentially due to enhanced infection control and better nurse-to-patient ratios. However, hospital stays were longer during the COVID phase.

Conclusion: While COVID-19 led to reduced admissions and delayed surgeries, mortality and sepsis rates improved, likely from heightened hygiene protocols and reduced patient volumes. These findings highlight the need for robust infection control and adequate staffing to improve neonatal surgical outcomes in LMICs.