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Mortality-related factors in gastroschisis - a Jamaican perspective
Sarah G Marshall Niles1, Kathryn Mitchell-Fearon2, Mitchell I Gill1
1Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies.
Objective:
To determine the mortality rate of patients treated with gastroschisis at a Jamaican pediatric hospital, and to identify factors that contribute significantly to mortality.
Methods:
Eighty-five patients were treated with gastroschisis between November 1, 2006 and November 30, 2015. Of these, 80 records were recovered and reviewed retrospectively. Records were analyzed for maternal and patient characteristics, and details of the clinical course. Death during admission was the primary outcome measure.
Results:
63 of the 80 patients died during admission, giving a mortality rate of 78.8%. Sepsis was the main cause of death (82.4%). 27 patients (33.8%) had complicated gastroschisis (necrosis, perforation and/or atresia), all of whom died. Only preterm gestational age, complicated gastroschisis, and the lack of parenteral nutrition were found to be statistically associated with increased mortality.
Conclusion:
Our mortality rate is higher than those quoted in high-income countries, and correlates to those found in low- to middle-income countries. Mortality in our cohort was significantly associated with prematurity, complicated gastroschisis, and the lack of parenteral nutrition. Efforts to improve outcome must focus on improving antenatal care, establishing transfer protocols, and optimizing nutrition for all patients with gastroschisis.
Study Type:
Prognostic/Retrospective Study LEVEL OF EVIDENCE: Level II.
