Hypothermia and sepsis: the major causes of mortality in gastroschisis

From 1984 to 1993, 25 neonates with gastroschisis were treated at Chianghua Christian Hospital (CCH). Twenty-one patients were outborn, and only four were inborn babies. Eighteen patients were treated by primary fascial closure of the abdominal wall defect and seven, by the silastic sac technique. One patient required creation of intestinal stomas for ileal atresia; Two patients received further operation because of pus formation and intestinal obstruction. Four patients (16%) had associated anomalies, including one ileal atresia, two malrotations and one deformity of the hand. Seven (28%) patients were small for their gestational age. Eight patients died (32%); 17 survived (68%). Nine patients (36%) were hypothermic upon arrival at the hospital, with body temperatures of 32.5 degrees C to 35.8 degrees C. Among those, three died of intractable metabolic disorders related to hypothermia and two who were hypothermal and acidotic, developed sepsis and expired. Six patients (24%) developed sepsis and only one survived. Metabolic acidosis related to hypothermia and sepsis were the major causes of death in this study (P values of 0.024 and 0.01 respectively). It is no doubt that an experienced pediatrician is essential for immediate neonatal care to prevent unnecessary insults.