Background: Published pediatric surgical outcome studies frequently focus on a single diagnosis or procedure. General surgery-led government hospitals, however, often manage a heterogeneous, neonatal-dominant abdominal surgical workload. The clinically relevant question in such settings is not whether one procedure outperforms another, but the magnitude and pattern of early morbidity, recovery delay, and critical-care use across the service.

Methods: This prospective observational cohort included 60 consecutive patients aged <18 years who underwent an abdominal operation at a government tertiary hospital between March 2024 and October 2025. The primary outcome was any recorded postoperative complication during the index admission and follow-up period. Secondary outcomes were complication-event profile, NICU/ICU utilization, duration of critical-care and hospital stay, return of bowel sounds, initiation of enteral feeding, discharge, referral, and mortality. Analyses were descriptive; exploratory comparisons were unadjusted because only 19 patients experienced the primary outcome, precluding a reliable multivariable prediction model.

Results: Neonates comprised 28/60 (46.7%) and infants 14/60 (23.3%) of the cohort. Forty patients (66.7%; 95% CI 54.1-77.3) required NICU/ICU care. Any postoperative complication occurred in 19/60 patients (31.7%; 95% CI 21.3-44.2). A total of 37 complication events were recorded among affected patients (mean 1.95 events per affected patient): wound infection in 15 (25.0%), fever in 13 (21.7%), paralytic ileus in 7 (11.7%), and sepsis in 2 (3.3%). Mean critical-care stay was 7.93 ± 3.77 days and mean hospital stay was 18.10 ± 5.20 days. Bowel sounds returned at 4.38 ± 1.42 postoperative days and enteral feeding began at 6.33 ± 1.48 days. Fifty-five patients were discharged (91.7%; 95% CI 81.9-96.4), four were referred, and one died (1.7%; 95% CI 0.3-8.9). Exploratory age- and procedure-based comparisons were not statistically significant.

Conclusion: This neonatal-dominant cohort demonstrated substantial early morbidity, delayed gastrointestinal recovery, and high critical-care utilization despite low observed mortality. The study should be interpreted as a service-level benchmark rather than a predictor study. Its principal actionable signal is the combination of frequent wound-related morbidity and late enteral feeding, supporting prospective implementation and evaluation of standardized infection-surveillance and pediatric enhanced-recovery pathways.