Journal of Neonatal Surgery | Year: 2021 | Volume: 10 | Page ID: 22 Anorectal malformations: Early outcome analysis in a tertiary care center in India Priya Mathew, 1 Arun Kumar Gupta, 1 Rahul Gupta, 1* Dharmesh Sharma, 2 1 Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India 2 Department of Preventive and Social Medicine, SMS Medical College, Jaipur, Rajasthan, India Correspondence*: Dr. Rahul Gupta, MS, M.Ch. (Paediatric Surgery) FMAS, Associate Professor, Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India. E-mail: meetsurgeon007@gmail.com KEYWORDS ABSTRACT Anorectal malformation, Associated anomalies, Colostomy, Mortality, Neonates, Outcomes Background: Delayed diagnosis, referral, and presence of associated anomalies may influence the outcome of Anorectal malformations (ARM). The aim of this study was to analyze the early outcomes (1 month postoperatively) of ARM presenting in the neonatal period. Methods: A prospective study was carried out in our tertiary care teaching institute from December 2018 to March 2020. All neonates admitted in the NICU with ARM were studied. Results: There were 315 neonates; out of these, 236 (74.92%) were male and 79 (25.07%) were female. High ARM (HARM) was present in 265 (84.13%) and low ARM (LARM) in 50 (15.87%). Associated congenital anomalies were noted in 121 (38.41%). Major associated anomalies consisted of gastrointestinal (GIT) (41.32%), oesophageal (31.4%), and genitourinary (GU) (19.83%). Out of 306 procedures for ARM, 196 (64.05%) neonates underwent left transverse colostomy (LTC). The most frequent postoperative complications were thrombocytopenia (115) followed by sepsis (98). Colostomy prolapse was uncommon (2). The overall mortality was 87/315 (27.61%) neonates - 82/265 (30.94%) in HARM and 5/50 (10%) in LARM. Neonatal mortality was significantly high with birth weight <2500gm 55/153 (35.94%; p value= 0.0001), associated malformations 82 (67.76%, p value= 0.003); and delayed presentation 40/87 (45%), and with primary perforation 5/6 (83.33%). Conclusions: Higher mortality was associated with low birth weight, double/ triple atresia, neonatal GIT perforation, sepsis on admission, and those with oesophageal and cardiac anomalies. More than 1/3rd (38.41%) patients had associated anomalies; thus, a detailed systematic evaluation of all subtypes is paramount. INTRODUCTION Anorectal malformations (ARM’s) are a diverse group of congenital anomalies encompassing the lower gas- trointestinal tract, urinary, and /or genital sys- tem.[1,2] ARM has an incidence of 1:5000 live births.[1,2] According to Peña and Bechit, ARM has a varied presentation, ranging from low perineal fistula to high anomalies with complex surgical manage- ment.[1,3] It is frequently associated with anomalies affecting other organ systems referred to as the VACTERL association (5% to 31%).[4,5] Complex associated anomalies, low birth weight, de- lay in access to pediatric surgeons, septicemia, gut perforation have an adverse impact on the prognosis. Risk factors such as hypothermia, hypoglycemia, poor immunity, and sepsis are modifiable and can lead to a reduction in neonatal mortality.[6] Timely diagnosis, management of associated anomalies, efficient surgi- cal repair provide the best chance for a good func- tional outcome in patients.[7] We aimed to analyze the early outcomes (morbidity and mortality statistics) of a cohort of patients of ARM presenting in the neonatal period in a high-volume tertiary care teaching insti- tute from the north-western region of India. METHODS This was a prospective study performed with IRB approval, to evaluate the early outcomes (1 month postoperatively) of neonatal ARM in our tertiary care teaching institute. The patients were from the state of Rajasthan and adjoining districts from neighboring Original Article © 2021, Mathew et al. Submitted: 02-01-2021 Accepted: 01-05-2021 License: This work is licensed under a Creative Commons Attribution 4.0 International License. DOI: https://doi.org/10.47338/jns.v10.927