Gastroschisis: Bellwether for neonatal surgery capacity in low resource settings?

Abstract:

INTRODUCTION:Economic disadvantage may adversely influence the outcomes of infants with gastroschisis (GS). Gastroschisis International (GiT) is a network of seven paediatric surgical centres, spanning two continents, evaluating GS treatment and outcomes. MATERIAL AND METHODS:A 2-year retrospective review of GS infants at GiT centres. Primary outcome was mortality. Sites were classified into high, middle and low income country (HIC, MIC, and LIC). MIC and LIC were sometimes combined for analysis (LMIC). Disability adjusted life years (DALYs) were calculated and centres with the highest mortality underwent a needs assessment. RESULTS:Mortality was higher in the LICs and LMICs: 100% in Uganda and Cote d'Ivoire, 75% in Nigeria and 60% in Malawi. 29% and 0% mortality was reported in South Africa and the UK, respectively. Septicaemia was the commonest cause of death. Averted and non-avertable DALYs were nil in Uganda and Cote d'Ivoire (no survivors). In the UK (100% survival) averted DALYs (met need) was highest, representing death and disability prevented by surgical intervention. Performance improvement measures were agreed: a prospectively maintained GS register; clarification of the key team members of a GS team and management pathway. CONCLUSIONS:We propose the use of GS as a bellwether condition for assessing institutional capacity to deliver newborn surgical care. Early access to care, efficient multidisciplinary team working, appropriate resuscitation, avoidance of abdominal compartment syndrome, stabilization prior to formal closure and proactive nutritional interventions may reduce GS-associated burden of disease in low resource settings.

journal_name

J Pediatr Surg

authors

Ford K,Poenaru D,Moulot O,Tavener K,Bradley S,Bankole R,Tshifularo N,Ameh E,Alema N,Borgstein E,Hickey A,Ade-Ajayi N

doi

10.1016/j.jpedsurg.2016.02.090

subject

Has Abstract

pub_date

2016-08-01 00:00:00

pages

1262-7

issue

8

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(16)00204-9

journal_volume

51

pub_type

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