J. C. Apfeld2, Z. J. Kastenberg2, N. Macheka1, B. A. Mbuwayesango1, M. Bruzoni2, K. G. Sylvester2, S. M. Wren2 1Harare Children’s Hospital,Department Of Surgery,Harare, HA, Zimbabwe 2Stanford University School Of Medicine,Department Of Surgery,Stanford, CA, USA
Introduction:
Survival for infants with gastroschisis in developed countries has improved dramatically in recent years with mortality rates of 4-7%. Conversely, mortality rates for gastroschisis in Sub-Saharan Africa remain dismal at 40-60%. This study aimed to describe the burden of gastroschisis for the major pediatric hospital in Zimbabwe and to identify pre- and post-admission factors associated with in-hospital survival.
Methods:
We sorted the electronic records at Harare Children’s Hospital for abdominal wall defects (ICD-9 756.7) and cross-referenced the subsequent list with the local neonatal unit register. Paper records for these cases were retrieved from the 5,585 admissions to the neonatal unit in 2013, and clinical data was transcribed into a RedCAP database. Univariate analysis of gastroschisis patients was performed using SAS, and odds ratios were calculated to compare patients who survived versus died.
Results:
95 infants with gastroschisis were admitted to Harare Children’s Hospital in 2013. The minority(42%) were male, the mean birth-weight was 2208g, and the mean gestational age was 36 weeks. Mean maternal age was 19 years. Ninety-one newborns were outborn (outside of Harare Children’s Hospital), 78 born outside Harare Province, and 25 at home. The time from birth to admission was 11 hours (median 6.5). Eighty of 95 patients died (84.2%). The odds of survival were significantly decreased for infants weighing less than 2,500 grams (OR 0.15, 95%CI: 0.05-0.51), for those born at less than 36 weeks gestation (0.06, CI: 0.01-0.50), and for those born to teenage mothers (0.05, CI: 0.01-0.46). The odds of survival trended towards being decreased for those born before arrival to a hospital (0.16, CI: 0.02-1.34) and for those born outside Harare Province (0.35, CI: 0.10-1.22).
Conclusion:
Gastroschisis mortality at Harare Children’s Hospital (84%) is associated with a number of factors that are well known to increase the risk of infant mortality such as low birth weight and prematurity. The high mortality rate observed in this population, however, is also likely due to a number of potentially modifiable factors. These data highlight an important opportunity for the development of innovative approaches to prenatal diagnosis, transportation, nutritional support, surgical management, and augmentation of the existing neonatal and surgical workforce.