Letter to the Editor: Low Birth Weight is Independently Associated with Surgical Site Infections Following Neonatal Abdominal Surgery

To the Editor:

Despite all the advances made in neonatal surgery and intensive care, neonatal surgical mortality and morbidity remain high, especially in low- and middle-income countries. This is usually related not only to the severity of neonatal conditions, but also to the vulnerability of the neonate.^1–3 Surgical site infections (SSI) are among the leading health care-associated infections following neonatal abdominal surgery. These infections usually have major implications for health, economic, and social systems, including longer hospital stays, higher antibiotic use, increased antibiotic resistance, potential need for additional surgery and increased overall morbidity.^4,5 While burden of SSI is substantial, little is known about factors that may predict the occurrence of these postoperative complications after abdominal surgery in neonates. The aim of this study was to determine the risk factors for SSI following neonatal abdominal surgery.

We conducted a retrospective case-control study using medical records of neonates (0 to 28 d old) who had undergone abdominal surgery at our institution between January 2014 and December 2023. We used the chi-square test for categorical variables and the Mann–Whitney test for continuous variables. Variables that were statistically significant in the univariate analysis were used to generate a logistic regression model.

Among the 281 neonates who had abdominal surgery during the 10-year study period, 25 (8.9%) developed SSI within 30 postoperative days. Neonatal surgical conditions included Hirschsprung disease ([n = 59]; stoma creation [n = 48]; one-stage pull-through [n = 11]), anorectal malformations (n = 45; stoma creation), duodenal obstruction ([n = 41]; duodenoduodenostomy [n = 36]; web excision with duodenoplasty [n = 5]), hypertrophic pyloric stenosis (n = 25; pyloromyotomy), necrotizing enterocolitis (n = 23; stoma creation), small intestinal atresia ([n = 22]; primary anastomosis [n = 20]; stoma creation [n = 2]), diaphragmatic hernia (n = 13; defect closure), omphalocele (n = 20; defect closure), small bowel volvulus ([n = 13]; untwisting of the affected bowel segment [n = 8]; resection of gangrenous segments with primary anastomosis [n = 3] and with stoma [n = 2]), incarcerated inguinal hernia (n = 13; open herniotomy), biliary atresia (n = 3; Kasai portoenterostomy), gastroschisis (n = 3; defect closure), and enteric duplication (n = 1; resection and primary anastomosis). Univariate analysis comparing SSI and non-SSI groups showed that birth weight <2500 g, gestational age <37 weeks, and duration of surgery >122 min were potential risk factors for SSI (Table 1). Multivariate statistical analysis revealed that only birth weight <2500 g was independently associated with the occurrence of SSI following abdominal surgery in neonates.

Although prematurity and long surgery time seem to increase the incidence of SSI, our study demonstrated that only low birth weight was independently associated with the occurrence of SSI after neonatal abdominal surgery. We believe that these findings should be communicated to pediatricians, neonatologists, and pediatric surgeons in order to take appropriate action and provide adequate information to the infant’s parents. On the basis of these results, we also plan to launch an awareness-raising campaign among health professionals on preventive control measures, with a view to reducing our rate of SSI after neonatal abdominal surgery.