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A 25-year study of gastroschisis outcomes in a middle-income country
Marcelo Eller Miranda1, Sherif Emil2, Ricardo de Mattos Paixão1
1Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais; Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil.
Insights
Implementing protocolized management significantly improved outcomes for newborns with gastroschisis in a middle-income country. This approach enhanced prenatal diagnosis, delivery, and treatment, leading to better results for this congenital condition.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Malformations
Background:
- Newborn survival rates for gastroschisis vary significantly between high-income and low-to-middle-income countries.
- This study examines the impact of protocolized management on gastroschisis treatment and outcomes in a middle-income country setting.
Purpose of the Study:
- To evaluate the effectiveness of implementing standardized protocols for gastroschisis management.
- To compare outcomes before and after the introduction of a protocolized approach in a Brazilian academic surgical service.
Main Methods:
- Retrospective analysis of 156 newborns with gastroschisis treated between 1989 and 2013.
- Introduction of protocolized diagnosis, delivery, nutrition, and interventions in 2002.
- Comparison of outcomes using univariate and multivariate analyses before and after protocol implementation.
Main Results:
- The post-2002 cohort (121 patients) showed higher rates of prenatal diagnosis, tertiary center delivery, early closure, primary repair, bladder pressure monitoring, PICC placement, and enteral feeding.
- Lower rates of electrolyte disturbances were observed in the later cohort.
- Despite an increase in complex gastroschisis cases, mortality decreased from 34.3% to 24.8% after protocol introduction.
Conclusions:
- Targeted interventions and standardized management protocols can gradually improve outcomes for gastroschisis in middle-income countries.
- Protocolized care is a viable strategy to enhance neonatal surgical outcomes in resource-limited settings.
Background:
Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management.
Methods:
All newborns with gastroschisis treated during the period 1989-2013 at a single Brazilian academic surgical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis.
Results:
One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of prenatal diagnosis (90.9% vs. 60.0%, p < 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p < 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p < 0.001), early initiation of enteral feeding (54.5% vs. 20.0%, p < 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period.
Conclusions:
Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols.
Type Of Study:
Therapeutic.
Level Of Evidence:
III.
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