A 25-year study of gastroschisis outcomes in a middle-income country

Influence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil

“…The mortality rate of 33.8% observed in this study is higher than studies conducted in other states of the southeast region of Brazil (4%–14.9%); 13 , 14 , 20 lower than the ones reported by the study carried out in the north (51.2%) and northeast part of the country (51.6%), 11 , 12 and close to a study also conducted in southeastern Brazil that showed a total mortality rate from gastroschisis of 26.9%. 19 However, Miranda et al compared patients before and after implantation of protocols for monitoring pregnant women of fetuses with gastroschisis from antenatal diagnosis to the evolution of newborns in NICU at a regional center. They observed a decrease in gastroschisis mortality rate from 34.3% to 24.8%, despite the increase in rate of complex gastroschisis from 11.4% to 15.7% in the same period.…”

“…This result corroborates the importance of monitoring gastroschisis cases in tertiary reference centers, with the implementation of protocols for improving quality of care. 19 …”

“…Prenatal and perinatal variables were maternal age (years), parity (primiparous or multiparous), antenatal diagnosis (yes or no), ultrasound (US) result (normal, gastroschisis, other malformation, not performed), number of prenatal care consultations (≤5 or >5), route of delivery (cesarean section or vaginal delivery), APGAR bulletin (score 0–10), gestational age (weeks) by CAPURRO method (most used in term newborns or borderline preterm infants), birth weight (grams), gender (female or male), the time between birth and first repair surgery (hours). Variables of postoperative assistance were simple or complex gastroschisis, classified according to aspect of loops as reported by surgeon; 17 , 18 simple (normal intestinal loops with or without malrotation) and complex (high degree of abdominovisceral disproportion, atresias, strictures, volvulus, necrosis), time of mechanical ventilation (MV) (time and percentage of days to extubation/ ≤ or >15 days (the cutoff point was based in Miranda et al), 19 time to first enteral feeding (mean), time to full enteral feedings (mean), time on parenteral nutrition (PN) (mean), use of vasoactive substances (yes or no), use of antimicrobials (1, 2 or more regimens), type of venous access (peripherally inserted central catheter — PICC, deep venipuncture, venous dissection or peripheral venoclysis), use of blood products, serum sodium in milliequivalent per liter (mEq/L) first dosage in first week of life (normal reference values between 135 to 145 mE/L-, serum albumin in grams per deciliter (g/dL) -first dosage in first week of life, normal reference values between 3.5 to 4.8 g/dL), neonatal clinical and/or comproved sepsis diagnosed by attending physician (yes or no), short bowel syndrome (yes or no), length of hospital stay (days) and discharge outcome (death or alive).…”

Dismal outcome of gastroschisis in a resource-limited country in West Africa: Relevant issues and what to expect?

“…Other authors have had few deaths: 12 deaths out of 302 in the series by Bradnock [24] in England, 3 deaths out of 22 in the series by Capelle in France [25], and 8% of deaths in Texas in the series by Eggink [26] over 20 years (1983-2003). In Brazil, Miranda [27] found mortality of 34.3% before 2002 and 24.8% after 2002 in a 25-year study (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003).…”