Gastroschisis: Bellwether for neonatal surgery capacity in low resource settings?
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Published on: August 23, 2022
Kat Ford1, Dan Poenaru2, Olivier Moulot3
1King's Centre for Global Health, London, UK; King's College Hospital, London, UK.
Insights
Infants with gastroschisis (GS) have higher mortality in low-income countries. Improving surgical care capacity, multidisciplinary teamwork, and early interventions can reduce GS-related deaths and disability globally.
Area of Science:
- Pediatric Surgery
- Global Health Equity
- Neonatal Care
Background:
- Economic disadvantage significantly impacts outcomes for infants with gastroschisis (GS).
- The Gastroschisis International (GiT) network comprises seven international pediatric surgical centers evaluating GS treatment and outcomes.
Purpose of the Study:
- To assess the influence of economic factors on gastroschisis outcomes across diverse healthcare settings.
- To identify disparities in gastroschisis mortality and disability-adjusted life years (DALYs) between high, middle, and low-income countries.
Main Methods:
- A 2-year retrospective review of infants with gastroschisis across seven international centers.
- Classification of participating centers into high, middle, and low-income countries (HIC, MIC, LIC), with MIC and LIC sometimes combined (LMIC).
- Calculation of mortality rates and disability-adjusted life years (DALYs); needs assessment for centers with highest mortality.
Main Results:
- Significantly higher mortality rates observed in LICs and LMICs (e.g., 100% in Uganda and Cote d'Ivoire) compared to HICs (0% in the UK).
- Septicemia was the most frequent cause of death among infants with gastroschisis.
- Disability-adjusted life years (DALYs) were highest in the UK, reflecting successful prevention of death and disability through surgical intervention.
Conclusions:
- Gastroschisis (GS) can serve as an indicator for assessing institutional capacity in newborn surgical care.
- Strategies to reduce the burden of gastroschisis in low-resource settings include early access to care, efficient multidisciplinary teams, and optimized perioperative management.
- Improvements in resuscitation, avoidance of abdominal compartment syndrome, stabilization, and nutritional support are crucial for better outcomes.
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.
