Improving outcomes for neonates with gastroschisis in low-income and middle-income countries: a systematic review protocol

Wright, Naomi Jane; Langer, Monica; Norman, Ian; Akhbari, Melika; Wafford, Q. Eileen; Ade-Ajayi, Niyi; Davies, Justine; Poenaru, Dan; Sevdalis, Nick; Leather, Andrew

doi:10.1136/bmjpo-2018-000392

Cited by 17 publications

(17 citation statements)

References 34 publications

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“…Systematic review. The systematic review will evaluate all published and unpublished literature regarding interventions to reduce mortality from gastroschisis in LMICs 109 . Articles on a wider range of gastro-intestinal congenital anomalies will also be included to evaluate generic neonatal surgery interventions utilised in LMICs, which may also benefit neonates with gastroschisis.…”

Section: Methodsmentioning

confidence: 99%

Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings

et al. 2019

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Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary paediatric surgery centres across SSA. Methods: A hybrid type-2 effectiveness-implementation, pre-post study design will be utilised. Using current literature an evidence-based, low-technology interventional bundle has been developed. A systematic review, qualitative study and Delphi process will provide further evidence to optimise the interventional bundle and implementation strategy. The interventional bundle has core components, which will remain consistent across all sites, and adaptable components, which will be determined through in-country co-development meetings. Pre- and post-intervention data will be collected on clinical, service delivery and implementation outcomes for 2-years at each site. The primary clinical outcome will be all-cause, in-hospital mortality. Secondary outcomes include the occurrence of a major complication, length of hospital stay and time to full enteral feeds. Service delivery outcomes include time to hospital and primary intervention, and adherence to the pre-hospital and in-hospital protocols. Implementation outcomes are acceptability, adoption, appropriateness, feasibility, fidelity, coverage, cost and sustainability. Pre- and post-intervention clinical outcomes will be compared using Chi-squared analysis, unpaired t-test and/or Mann-Whitney U test. Time-series analysis will be undertaken using Statistical Process Control to identify significant trends and shifts in outcome overtime. Multivariate logistic regression analysis will be used to identify clinical and implementation factors affecting outcome with adjustment for confounders. Outcome: This will be the first multi-centre interventional study to our knowledge aimed at reducing mortality from gastroschisis in low-resource settings. If successful, detailed evaluation of both the clinical and implementation components of the study will allow sustainability in the study sites and further scale-up. Registration: ClinicalTrials.gov Identifier NCT03724214.

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Section: Methodsmentioning

confidence: 99%

Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings

et al. 2019

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“…It has 75% to 100% mortality in low middle-income countries while it is <4% in high-income countries. [24] In our study, the majority of mortality in both groups happened within 7 days of operation. Schmedding et al also reported that half of gastroschisis mortality patients and 44% of omphalocele mortality patients expired in the first 10 days of life.…”

Section: Discussionmentioning

confidence: 46%

“…There was a huge difference in our mortality rates as compared to various other studies. [15][16][17][18][19][20][21][22][23][24] These differences might be due to various demographic and environmental factors in middle-income countries like India. Wright et al emphasized the role of surgical intervention in the survival of gastroschisis and documented a high mortality rate with contrasting statistics.…”

Section: Discussionmentioning

confidence: 99%

Anterior abdominal wall defects: Demographic and clinical profile and outcome at a tertiary care hospital

2021

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Background: The anterior abdominal defects, especially gastroschisis and omphalocele have high mortality rates in developing countries. Time to intervene has been hypothesized to be associated with morbidity and mortality. The aim was to determine factors affecting mortality in neonates with anterior abdominal wall defects. Methods: This retrospective descriptive study was done at a tertiary pediatric care center. The medical records of patients with a diagnosis of anterior abdominal defects (omphalocele/gastroschisis/umbilical cord hernia) admitted at our center from Jan 2015 to Dec 2019 were retrieved. The demographic and clinical data were studied including age, sex, religion, gestational age, associated anomalies, electrolytes at admission, septic profile, operative details, length of hospital stay, and mortality. The statistical data was fed on a Microsoft Excel worksheet and analysis was done. Results: Thirty-nine (39) neonates were included in the study. M:F ratio was 2:1, with 61.5% belonging to the Hindu religion. The majority had term gestation (87.2%). Birth weight ranged from 1.5 to 4 kg (mean 2.47 + 0.5 kg). Eighteen (18) neonates had gastroschisis, 15 omphalocele major and 6 omphalocele minor, with a median age of presentation at 1 day of life. Time to intervention ranged from 0 to 5 days (interquartile range 1-1.25 days) after admission. Primary closure could be achieved in the majority (66.7%), while ventral hernia was created in 17.9% and the silo was needed in the rest. The mean postoperative length of stay was 9.31 days (+ 9.85 days) with a survival rate of 51.3%. The mortality rate in gastroschisis and omphaloceles were 61.1% and 38.1% respectively. The significant factors for survival were time to intervene, birth weight, and primary abdominal wall closure. Conclusions: The present study brings out a different clinical profile of anterior abdominal wall defect patients. We recommend early surgery soon after stabilization and primary abdominal wall repair whenever abdominal pressures permit.

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“…Several literature reports submitted that there had been an unprecedented rise in the incidence of GS worldwide, especially in the last three decades [27,28]. Interestingly, the situation is indifferent, especially in the low-income and middle-income countries (LMICs), because the overall incidence is generally increasing [27,28]. Also, there is a rise in the number of cases presenting to a healthcare facility.…”

Section: Epidemiologymentioning

confidence: 99%

“…Also, there is a rise in the number of cases presenting to a healthcare facility. For instance, an estimated 35-fold surge in cases was reported in Pretoria, South Africa, between 1981 and 2001 [27,28]. The adjudged reason for such an increase in the prevalence could not be substantiated.…”

Section: Epidemiologymentioning

confidence: 99%

Giant gastroschisis with complete gastric herniation: A case report and review of the literature

Alegbeleye¹

2020

Iberoam J Med

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Introduction: We report a case of gastroschisis seen in our center, highlighting the rarity of this clinical entity. The author equally reviewed the existing literature covering the epidemiology, etiopathogenesis, management options, and outcomes of gastroschisis in low-income countries in sub-Saharan Africa and compares the reports with middle-income and high-income countries across the world. Case presentation: A preterm female neonate with a clinical diagnosis of gastroschisis at a primary care center was referred to the Neonatology Service of our tertiary care institution. She received optimal resuscitation and interdisciplinary management. Besides, the baby underwent an initial covering with an improvised silo bag of exposed bowel with unfavorable outcomes. Conclusion: The specific etiological factors for gastroschisis are yet to be established. The condition is considered a multifactorial disease. More frequently than ever, it's becoming easy to make prenatal diagnosis utilizing ultrasonography with high yield. Gastroschisis is a low-prevalence disease with an excellent prognosis if initial management is adequate. Interestingly, the condition requires highly skilled personnel of both specialized and primary care. Once the clinicians are well equipped, they can readily ensure correct initial management. Besides, the patient can equally benefit from an appropriate and timely referral to tertiary care centers to avoid future complications.

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Improving outcomes for neonates with gastroschisis in low-income and middle-income countries: a systematic review protocol

Cited by 17 publications

References 34 publications

Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings

Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings

Anterior abdominal wall defects: Demographic and clinical profile and outcome at a tertiary care hospital

Giant gastroschisis with complete gastric herniation: A case report and review of the literature

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