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Delivery room surgery: an applicable therapeutic strategy for gastroschisis in developing countries
1Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Shanghai, 200092, China.
Insights
Delivery room surgery improves survival rates for infants with gastroschisis in developing countries. Optimizing care for outborn infants is crucial for further reducing mortality in gastroschisis cases.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Gastroschisis survival rates are significantly lower in developing countries (50%) compared to developed nations (>90%).
- Investigating factors to improve outcomes for infants with gastroschisis in resource-limited settings is critical.
Purpose of the Study:
- To evaluate the impact of delivery room surgery on gastroschisis outcomes.
- To identify factors influencing survival and morbidity in neonates with gastroschisis, particularly in outborn infants.
Main Methods:
- Retrospective study of neonates with gastroschisis admitted after the implementation of delivery room surgery.
- Data analysis focused on comparing inborn versus outborn infants and identifying prognostic factors.
Main Results:
- Overall survival rate was 60.9%, with higher rates for inborn (76.5%) versus outborn (43.3%) infants.
- Outborn infants experienced delayed enteral feeding and longer hospital stays.
- Surgical technique, sepsis, and intestinal necrosis were identified as key factors affecting outcomes.
Conclusions:
- Delivering infants at a center equipped for immediate delivery room closure of gastroschisis enhances survival.
- Improving the care and management of outborn infants is essential for further reducing gastroschisis mortality.
Background:
The survival rate of infants with gastroschisis has improved significantly. It is over 90% in developed countries, but 50% in developing countries. This study aimed to investigate the factors improving the survival rate of infants with gastroschisis in developing countries.
Methods:
Neonates meeting the inclusion criteria, who presented to our center since the establishment of delivery room surgery, were enrolled into this retrospective study. Data were evaluated specifically to determine the role of delivery room surgery in reducing the mortality and morbidity of infants with gastroschisis and to identify factors optimizing the conditions of outborn infants.
Results:
A total of 64 infants were identified. The overall survival rate of the infants was 60.9%. The survival rate of infants in inborns was 76.5%, and the survival rate of infants in outborns was 43.3%. Infants of the outborn group took more time to reach full enteral feeding, and were more likely to require a prolonged stay in hospital when compared with those of the inborn group. Logistic analysis identified that the surgical technique, the presence of sepsis and intestinal necrosis could be expected to influence the outcome of gastroschisis.
Conclusions:
The strategy of delivery of patients in a center prepared to perform delivery room closure of gastroschisis appears to improve the survival of patients with gastroschisis. Further reduction in mortality rates will depend on improved conditions of outborn infants.
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