Keyword: Postoperative Rehabilitation

ABSTRACT: Congenital malformations of the gastrointestinal tract are a leading cause of neonatal surgical mortality and long-term disability, and outcomes remain markedly worse in low- and middle-income settings than in high-income countries, in part because of fragmented postoperative follow-up. We conducted a combined retrospective-prospective cohort study in the Samarkand region of Uzbekistan (2021–2024) to characterize the epidemiology and risk-factor profile of congenital gastrointestinal malformations and to evaluate a purpose-built, multistage, multidisciplinary rehabilitation program for infants after corrective surgery. Of 283 surgically treated neonates, 163 received the structured rehabilitation program (surgical, nutritional, physiotherapeutic, psychosocial and telemedicine components) and 120 received standard postoperative care. The rehabilitation program was associated with a shorter hospital stay (20.8 ± 3.2 vs 28.1 ± 3.5 days, p<0.001), a lower rate of postoperative complications (9.8% vs 25.7%, p<0.01), fewer unplanned readmissions at 6 months (11.0% vs 31.5%, p<0.01), and greater weight gain and serum protein/albumin recovery at 6 months (all p<0.01). Composite gastrointestinal functional recovery at 6 months was achieved in 90.2% of the program group versus 64.1% of the comparison group (p<0.001). Parental anxiety (State-Trait Anxiety Inventory) fell further in the program group (48.2±6.1 to 34.5±4.8) than in controls (47.8±6.3 to 42.9±5.2, p<0.001), and confidence in caregiving (visual analogue scale) improved correspondingly. A multivariable model incorporating birth weight, number of malformations and timing of nutritional rehabilitation predicted adverse outcome with 87.4% accuracy. These findings support multistage, family-centered, telemedicine-enabled rehabilitation as an effective and scalable strategy for improving postoperative outcomes after neonatal gastrointestinal surgery, particularly in resource-constrained regional health systems.