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Care of infants with gastroschisis in low-resource settings
Naomi J Wright1, John Sekabira2, Niyi Ade-Ajayi3
1King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, United Kingdom.
Insights
Gastroschisis outcomes vary globally, with high mortality in low-income nations due to care barriers. Improving neonatal surgical care through targeted interventions and global collaboration can enhance infant survival rates.
Area of Science:
- Neonatal Surgery
- Global Health
- Pediatric Surgery
Background:
- Gastroschisis outcomes show significant global disparities, with near 100% mortality in low-income countries.
- Key barriers include lack of antenatal diagnosis, inadequate neonatal care, limited intensive care, and poor surgical access.
- Lessons from high-income countries and low-resource initiatives offer pathways to improve survival.
Purpose of the Study:
- To identify and propose interventions to improve outcomes for infants with gastroschisis globally.
- To highlight the role of gastroschisis as an indicator for neonatal surgical care quality.
Main Methods:
- Review of management strategies in high-income countries and low-resource settings.
- Analysis of micro, meso, and macro-level interventions for improving neonatal care.
- Examination of global health guidelines and infrastructure development for neonatal nutrition.
Main Results:
- Micro/meso-level interventions: educational outreach, management protocols (resuscitation, silo use), multidisciplinary training, nurse empowerment, and maternal involvement.
- Macro-level interventions: integrating ultrasound into antenatal care (WHO), establishing infrastructure for parenteral nutrition.
- Gastroschisis serves as a critical indicator for evaluating neonatal surgical care access and outcomes.
Conclusions:
- A multi-pronged approach combining localized interventions with global health system improvements is crucial.
- Enhanced antenatal detection and improved neonatal care infrastructure are vital for reducing gastroschisis mortality.
- Gastroschisis management can serve as a benchmark for advancing global neonatal surgical care.
Abstract:
There is great global disparity in the outcome of infants born with gastroschisis. Mortality approaches 100% in many low income countries. Barriers to better outcomes include lack of antenatal diagnosis, deficient pre-hospital care, ineffective neonatal resuscitation and venous access, limited intensive care facilities, poor access to the operating theatre and safe neonatal anesthesia, and lack of neonatal parenteral nutrition. However, lessons can be learned from the evolution in management of gastroschisis in high-income countries, generic efforts to improve neonatal survival in low- and middle-income countries as well as specific gastroschisis management initiatives in low-resource settings. Micro and meso-level interventions include educational outreach programs, and pre and in hospital management protocols that focus on resuscitation and include the delay or avoidance of early neonatal anesthesia by using a preformed silo or equivalent. Furthermore, multidisciplinary team training, nurse empowerment, and the intentional involvement of mothers in monitoring and care provision may contribute to improving survival. Macro level interventions include the incorporation of ultrasound into World Health Organisation antenatal care guidelines to improve antenatal detection and the establishment of the infrastructure to enable parenteral nutrition provision for neonates in low- and middle-income countries. On a global level, gastroschisis has been suggested as a bellwether condition for evaluating access to and outcomes of neonatal surgical care provision.
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