Care of infants with gastroschisis in low-resource settings
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In brief
In brief
This article examines the stark mortality disparity for gastroschisis in low-income countries and identifies key barriers including lack of antenatal diagnosis, limited intensive care, and absence of parenteral nutrition. The authors propose evidence-based interventions at multiple levels—from bedside protocols using preformed silos to avoid early anesthesia, to macro-level policy changes incorporating ultrasound into WHO antenatal guidelines.
Written by the GCMD Library team from the article.
Publication date: October 2018
Source: Seminars in Pediatric Surgery, Volume 27, Issue 5
Author(s): Naomi J. Wright, John Sekabira, Niyi Ade-Ajayi
Abstract
There is great global disparity in the outcome of infants born with gastroschisis. Mortality approaches 100% in many low income countries. Barriers to better outcomes include lack of antenatal diagnosis, deficient pre-hospital care, ineffective neonatal resuscitation and venous access, limited intensive care facilities, poor access to the operating theatre and safe neonatal anesthesia, and lack of neonatal parenteral nutrition. However, lessons can be learned from the evolution in management of gastroschisis in high-income countries, generic efforts to improve neonatal survival in low- and middle-income countries as well as specific gastroschisis management initiatives in low-resource settings. Micro and meso-level interventions include educational outreach programs, and pre and in hospital management protocols that focus on resuscitation and include the delay or avoidance of early neonatal anesthesia by using a preformed silo or equivalent. Furthermore, multidisciplinary team training, nurse empowerment, and the intentional involvement of mothers in monitoring and care provision may contribute to improving survival. Macro level interventions include the incorporation of ultrasound into World Health Organisation antenatal care guidelines to improve antenatal detection and the establishment of the infrastructure to enable parenteral nutrition provision for neonates in low- and middle-income countries. On a global level, gastroschisis has been suggested as a bellwether condition for evaluating access to and outcomes of neonatal surgical care provision.