A retrospective (2004-2013) and prospective (2014-2015) study of new born with special reference to anorectal malformations over a period of 10 years at a tertiary care centre

Shashi Shankar Sharma, Arif Ahmad Ansari, Kartikeya Shukla, Ashok Laddha, Brijesh Lahoti


Background:A surgical audit of neonates with anorectal malformation in advanced tertiary neonatal care unit.

Methods: A retrospective (2004-2013) and prospective (2014-2015) audit of medical records of newborn with GIT disorders admitted in a tertiary care center of central India. The trends analyzed for the duration based on gender, region and birth weight and data base was generated depicting the burden of disease in the region. The data base for the prospective study was also compared with a tertiary center from Nigeria.

Results:Total 3309 admission included 73.56% (2438) patients of GIT diseases. Congenital anomalies were the most common cause in each category, major part being anorectal malformation (727) and trachea-esophageal fistula (730). Out of 727 admissions, 651 neonates were operated & total 1194 deaths recorded during this audit year 2004 to July 2015. Majority of new born admitted with were low birth weight male from rural skirts of this region. 509 have associated anomalies and 218 isolated ARM.  

Conclusions:There is significant increase in admissions in last decade with triple fold increase in GIT disorder and twice rate in anorectal malformation substantially increasing onwards. The quality of management has to continue further to achieve parity with international standards, as there is lack of antenatal screening and details of any antenatal checkup are scarce, for congenital anomalies at primary level. Early recognition, risk stratification of the baby and timely referral to higher pediatric surgery units is the way forward.


Surgical audit, Gastrointestinal disorders of new born, Anorectal malformations

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Joseph VT, Chan KY, Siew HF. Anorectal malformations and their associated anomalies. Ann Acad Med. 1985;14:622-25.

Spouge D, Baird PA. Imperforate anus in 100000 consecutive live-born infants. Am J Med Gen. 1986;2:151-61.

Shaul DB, Harrison EA. Classification of anorectal malformations: initial approach, diagnostic tests, and colostomy. Sem Pediatr Surg. 1997;6:187-95.

Hassink EAM, Rieu PNMA, Hamel BCJ, Severijnen RSVM, vd Staak FHJ, Festen C. Additional congenital defects in anorectal malformations. Eur J Pediatr. 1996;155:477-82.

Lerone M, Bolino A, Martucciello G. The genetics of anorectal malformations: a complex matter. Sem Pediart Surg. 1997;6:170-9.

Ameh EA, Ameh N. Providing safe surgery for neonates in sub-Saharan Africa. Trop Doct. 2003;33:145-7.

Bickler SW, Sanno-Duanda B. Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Organ. 2000;78:1330-6.

Nandi B, Mungongo C, Lakhoo K. A comparison of neonatal surgical admissions between two linked surgical departments in Africa and Europe. Pediatr Surg Int. 2008;24:939-42.

Smith ED. The bath water needs changing, but don’t throw out the baby: an overview of anorectal Malformations. J Pediatr Surg. 1987;22:335-48.

Endo M, Hayashi A, Ishihara M, Maie M, Nagasaki A, Nishi T et al. Analysis of 1992 patients with anorectal malformations over the past two decades in Japan. J Pediatr Surg. 1999;34:435-41.

Hoekstra WJ, Scholtmeijer RJ, Molenaar JC, Schreeve RH, Schroeder FH. Urogenital tract abnormalities associated with congenital anorectal anomalies. J Urol.1983;130:962-3.

Parrott TS. Urologic implications of anorectal malformations. Urol Clin North Am. 1985;12:13-21.

Boemers TM, Beek FJ, van Gool JD, de Jong TP, Bax KM. Urologic problems in anorectal malformations, part 1: urodynamic findings and significance of sacral anomalies. J Pediatr Surg. 1996;31:407-10.

Metts JC, Kotkin L, Kasper S, Shyr Y, Adams MC, Brock JW III. Genital malformations and coexistent urinary tract or spinal anomalies in patients with im-perforate anus. J Urol. 1997;158:1298-300.