Health Care-Associated Infections following Major Neonatal Surgery in a Resource-Limited Setting: Risk Factors and Outcomes from Southern Tunisia

Objective: Health care-associated infections (HAIs) remain among the most serious complications in neonatal surgery, particularly in resource-limited settings where infection control is often suboptimal. This study aimed to identify risk factors for HAIs following major thoracic and abdominal neonatal surgery in southern Tunisia. Study Design: We conducted a retrospective cohort study of neonates who underwent major non-cardiac abdominal or thoracic surgery at Hedi Chaker University Hospital, Sfax, Tunisia, between April 2015 and March 2025. Results: = 0.006). Conclusion: HAIs in neonatal surgery remain a major challenge in resource-constrained settings. In addition to patient- and surgery-related factors, structural limitations in perioperative care and infection control play a crucial role. Strengthening neonatal intensive care unit (NICU) capacity, ensuring consistent access to antibiotics and antiseptics, and optimizing perioperative protocols are essential to reduce infection rates and improve outcomes. Key Points: · Cardiac anomalies emerged as a significant independent predictive factor of HAIs in our cohort.. · Prematurity is an independent risk factor for HAIs following neonatal surgery.. · Prolonged surgical duration was independently associated with an increased risk of HAIs.. · Prolonged postoperative intubation emerged as a strong independent predictive factor of HAIs..