Gastroschisis in KwaZulu-Natal.
Loading...
Date
2008
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Gastroschisis is a full thickness abdominal wall defect, usually to the right of the umbilicus,
through which a variable amount of viscera herniates, without a covering membrane. Newborns
with gastroschisis present challenging problems to paediatric surgeons. The incidence of
gastroschisis is rising worldwide. In developed countries, advances in neonatal intensive care
have improved survival of patients with gastroschisis. In the few reported studies from Africa,
mortality rates of patients with gastroschisis are high. The aim of this study was to evaluate
outcome of gastroschisis from a centre in Africa with modern neonatal intensive care facilities.
Methods: A retrospective analysis of all neonates admitted with the diagnosis of gastroschisis
at Inkosi Albert Luthuli Central Hospital (IALCH) over a 6-year period (2002-2007).
Proportions in percentages were used for categorical variables. For continuous variables the
mean with standard deviation (SD) were derived. Two sampled t-test was used to show the pvalue
for the time to reduction between the non-survivors and survivors with a 95% confidence
interval.
Results: There was a significant increase in the prevalence of gastroschisis among neonatal
surgical admissions from 6.2% in 2003 to 15.2% in 2007. There were more females 53.4%, the
majority (71.7% had low birth weight and 64.2% were born prematurely. Although 75% (n=79)
of the mothers attended antenatal clinic, antenatal diagnosis by ultrasound was made in only 13
(n=12%)). Most of the babies 90.6% were out-born, with 70.8% delivered by normal vaginal
delivery (NVD), and 57.4% of the mothers were primiparous. Primary closure was achieved in
73.5% of the patients. The overall mean (SD) time from birth to primary surgical intervention
was 16 (13.04) hours and was higher 17(9.1) hours in those who died compared to survivors 15
(16.0), but the difference was not statistically significant, p=0.4465 and mortality was 43% with
sepsis as the leading cause. Staged closure with a plastic silo bag was associated with more than
double the mortality as compared to primary closure.
Conclusion: The prevalence of gastroschisis among neonatal surgical admissions has increased
in accordance with international trends. Due to lack of antenatal diagnosis, most of the babies
were out-born resulting into delay in offering surgical treatment. Mortality is still high despite
the presence of modern intensive care.
Description
Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.
Keywords
Abdominal wall--Abnormalities., Abdominal wall--Surgery., Paediatric epidemiology., Children--Surgery., Theses--Paediatric surgery.