Characteristics and outcomes of neonates with gastroschisis managed in a public tertiary hospital in a developing country

Abstract

Background. High survival rates in neonates with gastroschisis are reported in developed countries. Few studies have reported on prevalence and outcomes of neonates with gastroschisis from developing countries. 

Objectives. To determine prevalence, characteristics and mortality rates in neonates with gastroschisis managed in a public tertiary hospital in South Africa (SA). 

Methods. Hospital records of neonates with gastroschisis managed at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, SA from 2009 to 2016 were reviewed retrospectively for maternal and infant characteristics, management and outcome at hospital discharge. 

Results. A total of 97 neonates were admitted with gastroschisis, of whom 36 were born at CHBAH which had 167 822 live births over the 8-year period (prevalence of 2.1/10 000 live births); the remaining patients were referrals. Over two-thirds of patients were born to primigravida women and were of low birthweight. Complex gastroschisis was found in 36.3% of cases, with the majority (75%) requiring staged reduction. Mortality rate was 57%, with sepsis the most common cause. Factors associated with mortality were low birthweight (odds ratio (OR) 0.19; 95% confidence interval (CI) 0.04 - 0.80), stage reduction with delayed closure (OR 3.92; 95% CI 1.05 - 14.59), place of birth (OR 4.8; 95% CI 1.44 -16.05) and complex gastroschisis (OR 0.08; 95% CI 0.02 - 0.35). 

Conclusion. The mortality rate observed in this study was higher than that reported in developed countries. Antenatal diagnosis of this defect and adequate staff training at peripheral hospitals on the initial care and prevention of healthcare-associated infections could improve the outcomes of neonates with gastroschisis in developing countries.