Management of gastroschisis: Kenyan perspective

Abstract

Background:Gastroschisis is an anterior abdominal wall defect occurring in up to 4 babies per 10,000 live births. Though the anomaly is rarely associated with other disorders, it poses serious pathophysiological challenges that negatively affect outcome. Review of the management of gastroschisis at Moi Teaching & Referral Hospital (MTRH) from 2013-2016 was done to determine the outcome. Materials and Methods: A four year (2013-2016) retrospective review of gastroschisis management at MTRH was undertaken. Theatre records were used to track all files of babies admitted and operated on. The primary outcome of data analysis was survival. Secondary outcomes analyzed were age at admission, maternal age, birth order, associated anomalies and complications. Results: Records that were available for analysis were 107. Males were 58 (54%). Male to female ratio was 1.1:1. Mean age at admission was 1.35 ± 0.06 days. Weight ranged from 1250-3800 gm with a mean of 2330 gms. Majority were first born. Mean maternal age was 21.25 ± 3.62 years. Complex gastroschisis occurred in 12 (11%). Overall survival was 43%. However, of those who reached the stage of definitive treatment of containment (either primary closure or staged silo placement), had 48% survival rate. Survival rate was highest in the group who weighed 2500 gms and above. Poor outcomes were noted in the premature and low birth weight neonates, and those with complications. Sepsis was the leading cause of mortality. Length of hospital stay was an average of 24 days for the survivors. Conclusions & Recommendations: Prematurity, low birth weight, and complications negatively influenced survival. Improving obstetric care, establishment of paediatric surgical centres and neonatal support services are key to turning around the survival of neonates with this severe surgical anomaly.