Objective:

Abdominal distension is a common and potentially serious presentation in neonatal intensive care units (NICUs). This study aimed to investigate the etiologies, management, and outcomes of neonates with abdominal distension in a tertiary referral center in southern Iran.

Patients and Methods:

This retrospective study included all neonates admitted with abdominal distension to Namazi Hospital, Shiraz, from September 2021 to September 2024. Data were obtained from hospital records using a structured checklist and analyzed with SPSS version 26. The Mann–Whitney U test was used for continuous variables and the Chi-square test for categorical variables, with p < 0.05 considered significant.

Results:

A total of 171 neonates were included, 109 (63.7%) male and 62 (36.3%) female, with mean age at presentation 10.5 ± 12.1 days, gestational age 35.6 ± 4.5 weeks, and birth weight 2775.5 ± 781.6 g. Obstructive causes were found in 84 (49.1%) cases and non-obstructive in 87 (50.9%). The most frequent etiologies were unknown (19.9%), imperforate anus (19.9%), and Hirschsprung disease (18.1%). Congenital anomalies were present in 35.7%, mainly congenital heart disease (81.9%). Compared with non-obstructive cases, the obstructive group presented earlier (5.0 ± 8.3 vs. 14.0 ± 13.6 days, p < 0.001), had higher birth weight (2889.6 ± 711.1 vs. 2597.0 ± 725.1 g, p = 0.043), and longer hospital stay (10.9 ± 10.3 vs. 7.4 ± 6.7 days, p = 0.007). Overall mortality was 12.1% with no significant group difference (p = 0.28).

Conclusion:

Neonatal abdominal distension was nearly equally due to obstructive and non-obstructive causes, with congenital malformations being major contributors. Early diagnosis, screening for anomalies, and timely intervention are essential to improve outcomes.