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Gastroschisis: a third world perspective.

J Sekabira1, G P Hadley

  • 1Department of Paediatric Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.

Pediatric Surgery International
|March 17, 2009
PubMed
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Gastroschisis incidence is rising globally, with high mortality in Africa despite intensive care. Improvements in antenatal diagnosis, primary care, and sepsis management are crucial for reducing infant deaths.

Area of Science:

  • Pediatric Surgery
  • Neonatal Care
  • Public Health

Background:

  • Gastroschisis incidence is increasing worldwide.
  • Developed countries have improved survival rates with neonatal intensive care (NICU) and total parenteral nutrition.
  • Mortality rates for gastroschisis remain high in developing regions like Africa.

Purpose of the Study:

  • To evaluate the impact of modern intensive care facilities on gastroschisis mortality in African neonates.
  • To assess current trends and outcomes for gastroschisis in a South African tertiary hospital.

Main Methods:

  • Retrospective review of neonates diagnosed with gastroschisis.
  • Data collected over a 6-year period (2002-2007) at Inkosi Albert Luthuli Central Hospital.
  • Analysis included patient demographics, birth characteristics, management, and outcomes.

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Main Results:

  • 106 neonates with gastroschisis were identified; prevalence increased from 6% to 15% of surgical admissions.
  • Majority were "outborn" (91%), premature (64%), and low birth weight (<2.5 kg, 72%).
  • Overall mortality was 43%, with sepsis as the leading cause; staged closure had higher mortality than primary closure.

Conclusions:

  • Gastroschisis prevalence is rising, with many affected infants presenting late due to being "outborn".
  • High mortality persists despite NICU and total parenteral nutrition availability.
  • Reducing mortality requires enhanced antenatal diagnosis, improved primary care, efficient transportation, and better sepsis control.