Improvised Adaptations in Neonatal Surgery: Experience from a Resource-Constrained Tertiary Hospital in Nigeria

Abstract

Background: In many low-resource settings, neonatal surgical care is delivered without access to the specialised equipment and consumables considered standard in high-income environments. Clinicians must often adapt available materials to support safe perioperative care. Objective: To describe selected improvised techniques used in the perioperative care of neonates at a resource-limited tertiary hospital in South-South Nigeria. Methods: This descriptive report is based on clinical experience from the neonatal surgical unit of a tertiary hospital in South-south, Nigeria, between 2018 and 2024. Commonly used improvisations were selected based on their frequency and relevance to perioperative care. As the report does not involve data collection or experimental interventions, no statistical analysis or outcome measurements were included. Results: Five areas of adaptation were identified: thermoregulation, abdominal wall coverage, nutritional support, vascular access, and electrosurgical dissection. Techniques included the use of room heaters, sterile urine bags for silo creation, intravenous fluids with amino acid supplementation, umbilical vein catheterisation, and modified needle-tip cautery. While effective in our context, these methods have limitations compared to standard equipment. Conclusion: In resource-constrained settings, neonatal surgical teams can develop practical, context-appropriate adaptations. Documenting these experiences may support local protocol development and encourage innovation in similar environments.