A retrospective review of the outcomes of gastroschisis at a tertiary hospital in Cape Town

Van Eck, Andrew (2017-12)

Thesis (MScMedSc)--Stellenbosch University, 2017.

Thesis

ENGLISH ABSTRACT: Background The incidence of gastroschisis (GS) is rising and the outcomes in low to middle income countries are believed to be poor. Many studies from developed countries have evaluated prognostic factors and outcomes of GS, however there is little data from the developing world. Aim To determine the outcome of neonates treated for GS in a tertiary neonatal service in South Africa. Methods A retrospective case series of neonates admitted from January 2004 to July 2015 to the neonatal intensive care unit (NICU) at Tygerberg Children’s Hospital, Western Cape was conducted. Of the 39 cases, full clinical data was available for 31. All had surgery (primary closure or silo placement with delayed closure) and initial total parenteral nutrition (TPN). Main outcomes assessed were mortality rate, sepsis rate, time to full enteral feeding, occurrence of bowel related complications and the development of parenteral nutrition associated cholestasis (PNAC). Results Of the 31 neonates with GS, five (16%) cases were complex GS. Two (6.4%) neonates died. The culture proven sepsis rate was 46% and overwhelming infection was the most common cause of death. Seventy-one percent had no bowel related complications and the majority (67%) achieved full enteral feeding by 21 days. Six (24%) developed PNAC. Conclusion The outcome of GS in a single center tertiary hospital is comparable to that in high-income countries. The mortality and bowel complication rate is low, however there is a high rate of sepsis. To reduce mortality, strict infection prevention control is mandatory.

AFRIKAANSE OPSOMMING: Agtergrond Die insidensie van gastroskese styg en die uitkomste in lae to middle inkomste lande is swak. Baie studies vanaf ontwikkelde lande het die prognostiese faktore en uitkomste van gastroskese ge-evalueer maar daar is min data op hierdie gebied. Doel Om die uitkomste van neonate met gastroskese te evalueer in n tersiere neonatale diens in Suid Afrika. Metodiek n Retrospektiewe gevalle studie van neonate toegelaat vanaf Januarie 2004 tot Julie 2015 tot die neonatale intensiewe eenheid by Tygerberg Kinder Hospitaal, Wes Kaap is onderneem. Nege-en-dertig gevalle is geindentifiseer waarvan 31 gevalle volledige kliniese rekords gehad het. Alle babas het chirurgie ondergaan (primere sluiting of ‘silo’ plasing met vertraagde sluiting) en binneaarse voeding. Hoofuitkomste beoordeel was sterftesyfer, infeksiekoers, tyd tot volle enterale voeding, voorkoms van derm verwante komplikasies en die ontwikkeling van binneaarse voedings verwante cholestase. Resultate Van 31 neonate met gastroskese, was daar 5 (16%) met gekompliseerde gastroskese. Twee neonate het gesterf. Die kultuur positiewe infeksie insidensie was 46% en oorweldigende infeksie was die mees algemeenste oorsaak van sterfte. Ee-en-sewentig present (71%) het geen derm verwante komplikasies ontwikkel nie en die meerderheid (67%) het volle enterale voedings teen 21 dae bereik. Ses (23%) het binneaarse voedings verwante cholestase ontwikkel. Gevolgtrekking Die uitkomste van gastroskese in n enkel tersiere hospitaal in Suid Afrika is vergelykbaar met die van hoe-inkomste lande. Die sterftesyfer en buik-verwante komplikasie syfer is laag, maar daar is n hoe infeksie insidensie. Om die sterftesyfer te verminder, is streng infeksiebekamping verpligtend.

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