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

Abstract

Background: Gastroschisis often has a fatal outcome in developing countries. Its outcome is taken as an indicator of the level of healthcare in a particular healthcare facility. The aim was to study the outcome of the management of gastroschisis and to identify the main challenges of its treatment in a country with limited resources. Methods: This is a prospective and descriptive study conducted over a period of 4 years (2016-2020). It included all the neonates admitted to the two referral hospitals of our country with the diagnosis of gastroschisis. Each of the university hospitals had a neonatology unit. Parenteral nutrition and assisted ventilation were not available. Results: Twenty patients were admitted to our hospitals with an annual frequency of five cases. The sex ratio (M:F) was 1.5. Only one of the 20 mothers (5%) of the patients had an antenatal diagnosis and was the only one born in a university hospital. The remaining (19-95%) were referred to a university hospital after their birth. None of the 20 patients had received parenteral nutrition. Surgically, seven babies (35%) had benefited from the placement of a silo with progressive reduction of the bowels. The mortality of gastroschisis was 100% and the average life span of the patients was 4.5 days [1-20 days]. Conclusion: It is important to act appropriately on the whole chain of management of gastroschisis from antenatal diagnosis to treatment so that this pathology is no longer fatal for newborns in countries with limited resources.

Are multidisciplinary consultation meetings for prenatal diagnosis achievable in a low-income country? A descriptive cross-sectional survey in Benin

“…Its implementation would improve the neonatal management of certain conditions, such as gastroschisis, the mortality rate of which is still very high in our countries. 27 The management of conditions of particular severity detected in the prenatal period remains a problem to be solved. The number of pediatric surgeons, pediatric anesthetists, and geneticists being very low for the current growing population constitutes a manpower problem that the MCMPD will be able to solve by periodically pooling the difficulties for a solution to this infant mortality.…”

Constrained evidence-based practice

“…This approach may not help mitigate high morbidity and mortality in surgical neonates as exemplified by the dismal outcome of patients with gastroschisis in LICs. Assouto et al, [4] recently documented 100% mortality in patients with gastroschisis from Benin. Similarly, Wright et al, [1] compared the outcomes of various congenital anomalies in surgical neonates from 74 countries (Low-income countries-LICs, Middle-income countries-MICs, and High-income countries-HICs).…”