Gastroschisis: A Successful, Prospectively Evaluated Treatment Model in a Middle-Income Country
Pastor Escarcega-Fujigaki1, Guillermo Hernandez-Peredo-Rezk2, Naomi J Wright3
1Department of Pediatric Surgery, Centro de Alta Especialidad Dr. Rafael Lucio, Av Adolfo Ruiz Rortines 2903, col. Unidad Magisterial, Xalapa, Veracruz, Mexico. drpastor_ef@yahoo.com.
Insights
This study adapted a high-income country care protocol for gastroschisis in a middle-income country, achieving a 92.7% survival rate. The adapted protocol reduced patient fasting times and neonatal intensive care unit stays.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Global Health Equity
Background:
- Gastroschisis, a congenital abdominal wall defect, poses significant morbidity and mortality risks, particularly in middle-income countries.
- Existing care protocols often originate from high-income settings, presenting challenges for adaptation to resource-limited environments.
- Implementing evidence-based protocols is crucial for improving outcomes in neonatal surgical conditions.
Purpose of the Study:
- To evaluate the effectiveness of an adapted high-income country care protocol for gastroschisis in a level II/III hospital in a middle-income country.
- To assess the impact of the adapted protocol on patient survival rates, morbidity, and resource utilization.
- To determine factors associated with successful surgical management of gastroschisis.
Main Methods:
- A prospective study enrolled 55 neonates with gastroschisis from November 2012 to November 2018.
- A multidisciplinary protocol included prenatal diagnosis, immediate surgical/neonatal team presence, and either primary abdominal closure or preformed silo placement.
- Statistical analysis used Mann-Whitney, Student's t-test, chi-square, and Fisher's exact tests to compare outcomes.
Main Results:
- A 92.7% survival rate was achieved (51 out of 55 patients).
- Primary closure was associated with significantly shorter fasting durations and reduced neonatal intensive care unit length of stay.
- Prenatal diagnosis and the presence of a pediatric surgeon at birth correlated with successful primary closure.
Conclusions:
- The adapted care protocol, tailored to the hospital's resources, proved successful in reducing gastroschisis-related mortality and morbidity.
- This model demonstrates the feasibility of implementing advanced neonatal surgical care protocols in resource-constrained settings.
- Optimizing surgical approaches like primary closure can lead to improved patient recovery and resource efficiency.
Background:
This research adopted a care protocol from high-income countries in a level II/III hospital in a middle-income country to decrease morbidity and mortality associated with gastroschisis.
Methods:
We established a multidisciplinary protocol to treat patients with gastroschisis prospectively from November 2012 to November 2018. This included prenatal diagnosis, presence of a neonatologist and pediatric surgeon at birth, and either performing primary closure on the patients with an Apgar score of 8/9, mild serositis, and no breathing difficulty or placing a preformed silo, when unable to fulfill these criteria, under sedation and analgesia (no intubation) in the operating room or at the patients' bedside. The subsequent management took place in the neonatal intensive care unit. The data were analyzed through the Mann-Whitney and Student's t-distribution for the two independent samples; the categorical variables were analyzed through a chi-square distribution or Fisher's exact test.
Results:
In total, 55 patients were included in the study: 33 patients (60%) were managed with a preformed silo, whereas 22 patients (40%) underwent primary closure. Prenatal diagnosis (P = 0.02), birth at the main hospital (P = 0.02), and the presence of a pediatric surgeon at birth (P = 0.04) were associated with successful primary closure. The primary closure group had fewer fasting days (P < 0.001) and a shorter neonatal intensive care unit length of stay (P = 0.025). The survival rate was 92.7% (51 patients).
Conclusion:
The treatment model modified to fit the means of our hospital proved successful.
