Delivery room surgery: an applicable therapeutic strategy for gastroschisis in developing countries

Lei Du, Wei-Hua Pan, Wei Cai, Jun Wang, Ye-Ming Wu, Cheng-Ren Shi

Shanghai, China

Author Affiliations: Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Shanghai 200092, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China (Du L, Pan WH, Cai W, Wang J, Wu YM, Shi CR)

Corresponding Author: Wei Cai, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China (Tel: 021-65790000; Fax: 021-65125173; Email: caiw1978@163.com)

doi: 10.1007/s12519-014-0455-3

Background: The survival rate of infants with gas-troschisis has improved significantly. It is over 90% in developed countries, but 50% in developing countries. This study aimed to investigate the factors improving the survival rate of infants with gastroschisis in developing countries.

Methods: Neonates meeting the inclusion criteria, who presented to our center since the establishment of delivery room surgery, were enrolled into this retrospective study. Data were evaluated specifically to determine the role of delivery room surgery in reducing the mortality and morbidity of infants with gastroschisis and to identify factors optimizing the conditions of outborn infants.

Results: A total of 64 infants were identified. The overall survival rate of the infants was 60.9%. The survival rate of infants in inborns was 76.5%, and the survival rate of infants in outborns was 43.3%. Infants of the outborn group took more time to reach full enteral feeding, and were more likely to require a prolonged stay in hospital when compared with those of the inborn group. Logistic analysis identified that the surgical technique, the presence of sepsis and intestinal necrosis could be expected to influence the outcome of gastroschisis.

Conclusions: The strategy of delivery of patients in a center prepared to perform delivery room closure of gastroschisis appears to improve the survival of patients with gastroschisis. Further reduction in mortality rates will depend on improved conditions of outborn infants.

Key words: gastroschisis; neonatal surgery; outcomes analysis

World J Pediatr 2014;10(1):69-73