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Gastroschisis: a multi-centre comparison of management and outcome
Joanna Manson1, Emmanuel Ameh, Noel Canvassar
1Department of Paediatric Surgery, King's College Hospital, London, United Kingdom.
Insights
Outcomes for infants with gastroschisis are poorer in Africa than in Western nations, with significant variations in management and higher mortality rates. Improving neonatal care and surgical interventions could enhance survival in African regions.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Global Health Disparities
Background:
- Gastroschisis outcomes in African nations are reportedly worse than in Western countries.
- Limited literature exists on gastroschisis management and outcomes in Africa.
Purpose of the Study:
- To compare management strategies and outcomes for infants with gastroschisis in African and Western healthcare settings.
- To identify factors contributing to outcome disparities.
Main Methods:
- Retrospective review of 5 centers (3 African, 2 Western) from 2004-2007.
- Analysis of infant presentation, management strategies, and 30-day mortality.
- Comparison between African and Western cohorts based on catchment area size.
Main Results:
- Fewer infants with gastroschisis presented to hospitals in the African cohort relative to population size.
- Management strategies varied widely in Africa (primary closure, silo techniques), while Western centers favored preformed silos and delayed closure.
- 30-day mortality was significantly higher in the African cohort (23%) compared to the Western cohort (1%).
Conclusions:
- Gastroschisis management and outcomes in Africa are characterized by lower presentation rates and greater variability.
- Further epidemiological studies are needed to understand gastroschisis incidence in Africa.
- Interventions like improved resuscitation, neonatal transfer, silo use, and parenteral nutrition may improve outcomes.
Background:
Anecdotal evidence and a handful of literature reports suggest that the outcome for infants born with gastroschisis in many African countries is poor when compared to Western nations. We wished to evaluate current management strategies and outcomes in African and Western units that treat infants with gastroschisis.
Patients And Methods:
We conducted a retrospective review of case-notes for infants with gastroschisis who presented to a hospital between 1 January 2004 and 31 December 2007. There were five participating centres, divided for analysis into an African cohort (three centres) and a Western cohort (two centres).
Results:
Fewer infants presented to a hospital with gastroschisis in the African cohort when compared to the Western cohort, particularly when the size of catchment area of each hospital was taken into account. The physiological state of the infant on presentation and management strategy varied widely between centres. Primary closure, preformed silo and surgical silo with delayed closure were all utilised in the African cohort. Use of the preformed silo and delayed abdominal wall closure was the strategy of choice in the Western cohort. The 30-day mortality was 23% and 1% respectively. This primary outcome measure varied considerably in the African cohort but was the same in the two Western units.
Conclusions:
Gastroschisis in the African cohort was characterised by fewer infants presenting to a hospital and a more variable outcome when compared to the Western cohort. A detailed epidemiological study to determine the incidence of gastroschisis in African countries may provide valuable information. In addition, interventions such as prompt resuscitation, safe neonatal transfer, the use of the preformed silo and parenteral nutrition could improve outcomes in infants with gastroschisis.