Predicting Postoperative Mortality in Neonates with Congenital Gastrointestinal Anomalies: Development of a Prognostic Scoring System

Background: Congenital gastrointestinal anomalies (CGIAs) are the third most common congenital malformation globally, with a mortality rate reaching 39.8% in developing countries. Surgical intervention is often necessary for life-saving or corrective purposes. However, postoperative mortality in resource-limited settings can reach up to 50%. Identifying prognostic factors is essential to improve clinical management and inform family counseling regarding potential outcomes. Objectives: We aimed to develop a prognostic scoring system to predict postoperative mortality in neonates with CGIAs. Methods: This retrospective study analyzed medical records of neonates who underwent surgery for CGIAs between 2020 and 2024. Prognostic factors were identified using logistic regression analysis. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff points for mortality prediction. Results: A total of 282 neonates were included; 121 (42.9%) died and 161 (57.1%) survived. Multivariate logistic regression identified sepsis, mechanical ventilation, prematurity, and upper gastrointestinal anomalies as independent predictors of mortality. A scoring system was developed, with a score > 3 yielding a sensitivity of 83.5% and specificity of 72.0%. The area under the ROC curve (AUC) was 0.840 (p < 0.001). Conclusions: We developed a simple and reliable scoring system to predict postoperative mortality in neonates with CGIAs, which may support clinical decision-making and family counseling.