Improved Mortality of Patients with Gastroschisis: A Historical Literature Review of Advances in Surgery and Critical Care from 1960–2020

Abstract

The improved survival of gastroschisis patients is a notable pediatric success story. Over the past 60 years, gastroschisis evolved from uniformly fatal to a treatable condition with over 95% survival. We explored the historical effect of four specific clinical innovations—mechanical ventilation, preformed silos, parenteral nutrition, and pulmonary surfactant—that contributed to mortality decline among gastroschisis infants. A literature review was performed to extract mortality rates from six decades of contemporary literature from 1960 to 2020. A total of 2417 publications were screened, and 162 published studies (98,090 patients with gastroschisis) were included. Mortality decreased over time and has largely been <10% since 1993. Mechanical ventilation was introduced in 1965, preformed silo implementation in 1967, parenteral nutrition in 1968, and pulmonary surfactant therapy in 1980. Gastroschisis infants now carry a mortality rate of <5% as a result of these interventions. Other factors, such as timing of delivery, complex gastroschisis, and management in low- and middle-income countries were also explored in relation to gastroschisis mortality. Overall, improved gastroschisis outcomes serve as an illustration of the benefits of clinical advances and multidisciplinary care, leading to a drastic decline in infant mortality among these patients.

Pediatric perioperative mortality in Southeastern Nigeria—a multicenter, prospective study

“…[18] Neonates accounted for the majority (60.7% ) of deaths, mirroring Ademola et al's nding of 58.8% [12] Neonates encounter distinct challenges as they transit from intrauterine life to postnatal life, and going through surgery can disrupt this delicate balance, making them more vulnerable to sepsis, nutritional de ciencies, and respiratory problems. [19]The neonatal surgical mortality (NSM) rate was 19.8%, lower than reports from India (33.33%), [17] Bangladesh (14.6%), [20] and Tunisia [21] but higher than those from HICs. [14,[22][23][24] The lower neonatal mortality rates in HICs have been linked to advanced perioperative support systems, prenatal diagnosis, improved perinatal care, availability of NICUs, and TPN.…”

“…Others had gastrostomies with gastric banding due to late presentation with aspiration pneumonitis. All required prolonged ventilatory support, like the report by Puri et al (2019) [17] though this could not be sustained owing to the unavailability of NICU and requisite expertise, especially for the nursing care of such patients. The need for prolonged oxygen or ventilatory support has been linked to higher neonatal perioperative mortality.…”

“…[12,14,[25][26][27] Most (72%) mortalities were attributed to preoperative child conditions and overwhelming sepsis was the leading cause of death (53.6%), consistent with other reports on pediatric perioperative mortality rates. [12,14,17] Late presentation, often with complications and sepsis, is common in the subregion. [28,29] In the present study, all the patients who died from intussusception presented more than 24 hours of the onset of symptoms in poor clinical conditions, and some required multiple surgeries.…”

Nosocomial Infections Affecting Newborns with Abdominal Wall Defects

“…Abdominal wall defects (AWD) are serious congenital malformations with an increasing prevalence in some regions (1.85–1.96 per 10,000 births), with long periods of hospitalization and significant costs to the medical system [ 1 , 2 , 3 ]. In our country, the survival rate of newborns with omphalocele or gastroschisis is much lower than that of newborns in other countries in the European Union and United States of America [ 4 , 5 , 6 , 7 , 8 ]. The increased mortality rate in the case of AWD can be explained by the lack of antenatal diagnosis, low birth weight, association of serious congenital or genetic abnormalities, prolonged period of hospitalization and probably the occurrence of nosocomial infections (NI) and sepsis [ 6 , 7 ].…”

“…The incidence and risk factors for wound infections and nosocomial infection in adults and children have been defined and management guidelines have been established [ 11 ], but for neonates and infants, guidelines have not yet been established [ 5 , 9 , 12 ]. Incriminated factors for wound and NI in neonates are admission to a neonatal intensive care unit (NICU), a history of prematurity, a low birth weight, mechanical ventilation, central venous lines, associated co-morbidities, long-term use of antibiotics, abdominal surgery and neutropenia [ 7 , 8 , 13 , 14 ].…”