Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Nigel J. Hall, University of Southampton,
- Second opponent: Assistant professor Mercedes Pilkington, University of Toronto,
- Third member and chair of the evaluation committee: Associate professor Hans Christian Erichsen Landsverk, University of Oslo
Chair of the Defence
Professor II Pål Aksel Næss, University of Oslo
Principal Supervisor
Professor II Kristin Bjørnland, University of Oslo
Summary
Neonates undergoing surgery for congenital gastrointestinal anomalies are a highly vulnerable patient group with a high risk of postoperative complications and prolonged hospital stays. The survival rate is high. However, very little is known about long-term clinical outcomes and quality of life. Further, parental experiences and needs during the initial hospital stay are scarcely investigated.
In this thesis, short- and long-term outcomes for three of the most common congenital gastrointestinal anomalies (congenital duodenal obstruction, jejunoileal atresia, and gastroschisis) were investigated through review of medical records and questionnaire surveys. Postoperative complications were common, particularly surgical site infections and intestinal obstruction requiring reoperation. In the long term, approximately one third of patients had gastrointestinal symptoms, most commonly bloating, constipation, and diarrhoea. Further, one third had complaints regarding the surgical scar. Overall survival was 97%.
Parental experiences were explored in a focus group discussion. The parents described the burden of being separated from their baby and a strong desire to be more involved in daily care. The mothers were also worried about whether they would succeed with breastfeeding. Nevertheless, they felt their child was well cared for by competent healthcare professionals.
These findings formed the basis for a multimodal, multidisciplinary Enhanced Recovery Protocol for congenital duodenal obstruction. The protocol, which was implemented at Oslo University Hospital and St. Olav’s hospital, included recommendations for the whole perioperative course, including surgical technique, antibiotic use, nutrition, and parental involvement. The protocol was found to be safe and feasible, with early results suggesting clinical benefit. The thesis provides an important foundation for a comprehensive, evidence-based, and family-centred standardization of neonatal surgery in Norway.
Additional information
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