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Background <p>Neonatal intestinal atresia remains a significant cause of morbidity and mortality despite advances in neonatal intensive care, anesthesia, and neonatal surgical management. This systematic review and meta-analysis aimed to identify and quantify global prognostic factors associated with mortality and major postoperative morbidity in the modern surgical era.</p> Methods <p>A comprehensive systematic literature review and meta-analysis was conducted in major databases from January 2000 to February 2026. Studies reporting mortality or major morbidity (anastomotic leak, unplanned reoperation, sepsis) after surgical repair of intestinal atresia in neonates were included. Data were pooled using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity. Certainty of evidence was assessed with GRADE.</p> Results <p>Twenty-one studies comprising 2,040 neonates were included. The pooled mortality rate was 10% (95% CI 5–19%; I²=84%). Mortality was significantly higher in low- and middle-income countries and African studies (<i>p</i> &lt; 0.001). Sensitivity analyses confirmed the robustness of the findings. The pooled unplanned reoperation rate was 15.1% (95% CI 12.7–17.6%; I²=31%) and anastomotic leak rate was 7.5% (95% CI 4.8–13.0%; I²=53%). Independent prognostic factors for adverse outcomes included prematurity (OR 4.9), low birth weight (OR 28.27), associated anomalies (OR 35.34), meconium peritonitis (OR 3.29), and surgical technique (primary anastomosis vs. Bishop-Koop). Sensitivity analyses confirmed robustness of the findings. Certainty of evidence was moderate for mortality and high for reoperation.</p> Conclusion <p>In the modern era, mortality after neonatal intestinal atresia repair remains substantial, with marked disparities between high-income and low- and middle-income settings. Key modifiable and non-modifiable prognostic factors were identified that can inform risk stratification and clinical decision-making. Targeted, context-appropriate interventions in resource-limited settings are urgently needed to close the global survival gap.</p>

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Global prognostic factors for mortality and major postoperative morbidity in neonatal intestinal atresia in the modern surgical era: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年6月25日

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  • Rahman Khosravi,
  • Hatef Alizadeh

摘要

Background

Neonatal intestinal atresia remains a significant cause of morbidity and mortality despite advances in neonatal intensive care, anesthesia, and neonatal surgical management. This systematic review and meta-analysis aimed to identify and quantify global prognostic factors associated with mortality and major postoperative morbidity in the modern surgical era.

Methods

A comprehensive systematic literature review and meta-analysis was conducted in major databases from January 2000 to February 2026. Studies reporting mortality or major morbidity (anastomotic leak, unplanned reoperation, sepsis) after surgical repair of intestinal atresia in neonates were included. Data were pooled using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity. Certainty of evidence was assessed with GRADE.

Results

Twenty-one studies comprising 2,040 neonates were included. The pooled mortality rate was 10% (95% CI 5–19%; I²=84%). Mortality was significantly higher in low- and middle-income countries and African studies (p < 0.001). Sensitivity analyses confirmed the robustness of the findings. The pooled unplanned reoperation rate was 15.1% (95% CI 12.7–17.6%; I²=31%) and anastomotic leak rate was 7.5% (95% CI 4.8–13.0%; I²=53%). Independent prognostic factors for adverse outcomes included prematurity (OR 4.9), low birth weight (OR 28.27), associated anomalies (OR 35.34), meconium peritonitis (OR 3.29), and surgical technique (primary anastomosis vs. Bishop-Koop). Sensitivity analyses confirmed robustness of the findings. Certainty of evidence was moderate for mortality and high for reoperation.

Conclusion

In the modern era, mortality after neonatal intestinal atresia repair remains substantial, with marked disparities between high-income and low- and middle-income settings. Key modifiable and non-modifiable prognostic factors were identified that can inform risk stratification and clinical decision-making. Targeted, context-appropriate interventions in resource-limited settings are urgently needed to close the global survival gap.