João P Bilibio1, Alinne M Beltrão2, Ana C Vargens3, Thiago B Gama4, Pânila L Lorenzzoni5. 1. Department of Obstetrics and Gynecology, Universidade Federal do Pará, Belém, Pará, Brazil; Programa de Pós Graduação do Núcleo de Medina Tropical da, Universidade Federal do Pará, Belém, Pará, Brazil; Postdoctoral Program of the Programa de Pós Graduação de Ciências Médicas da, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Grupo de Pesquisa Bilibio, Universidade Federal do Pará, Belém, Pará, Brazil. Electronic address: joaopaolobilibio@yahoo.com.br. 2. Programa de Pós Graduação do Núcleo de Medina Tropical da, Universidade Federal do Pará, Belém, Pará, Brazil; Grupo de Pesquisa Bilibio, Universidade Federal do Pará, Belém, Pará, Brazil. 3. Department of Obstetrics and Gynecology, Universidade Federal do Pará, Belém, Pará, Brazil; Grupo de Pesquisa Bilibio, Universidade Federal do Pará, Belém, Pará, Brazil; Programa de Residência Médica em Ginecologia e Obstetrícia, Hospital Bettina Ferro de Souza, Universidade Federal do Pará, Belém, Pará, Brazil. 4. Department of Obstetrics and Gynecology, Universidade Federal do Pará, Belém, Pará, Brazil; Grupo de Pesquisa Bilibio, Universidade Federal do Pará, Belém, Pará, Brazil. 5. Grupo de Pesquisa Bilibio, Universidade Federal do Pará, Belém, Pará, Brazil.
Abstract
OBJECTIVE: To evaluate the prognostic factors related to mortality in neonates with gastroschisis, ranging from prenatal care to corrective surgery. STUDY DESIGN: A retrospective cohort study was conducted and included neonates with gastroschisis who underwent surgical correction from 2010 to 2015. The patients were divided into two groups based on postoperative outcomes: those who were discharged and those who died postoperatively. Data regarding demographics, prenatal history, delivery route, surgery and postoperative outcomes were collected in both groups. RESULTS: In total, 168 patients were eligible; 82 (48.8%) were discharged, and 86 (51.2%) died postoperatively. Fewer prenatal visits (4.85 versus 6.05 visits, P = 0.004), delayed prenatal diagnosis (27.6 versus 22.2 weeks of gestational age, P = 0.005), low birth weight (2159 versus 2444 g, P < 0.001), intestinal injury (OR 5.5, P = 0.001) and sepsis (OR 112.1, P < 0.001) were associated with infant mortality. The type of delivery and the mean time between birth and the first corrective surgery (16.2 versus 21.1 h, P = 0.071) were not associated with increased neonatal mortality; however, the newborns who underwent their first corrective surgery after less than 4 h of life had lower mortality, and surgery performed after more than 4 h of life increased the risk of mortality (OR 2.7, CI 1.2-6.3, P 0.014). CONCLUSION: The mortality rate was high (51.2%) and was associated with inadequate prenatal care, low birth weight, gestational age, the severity of intestinal injury, infection and septicemia.
OBJECTIVE: To evaluate the prognostic factors related to mortality in neonates with gastroschisis, ranging from prenatal care to corrective surgery. STUDY DESIGN: A retrospective cohort study was conducted and included neonates with gastroschisis who underwent surgical correction from 2010 to 2015. The patients were divided into two groups based on postoperative outcomes: those who were discharged and those who died postoperatively. Data regarding demographics, prenatal history, delivery route, surgery and postoperative outcomes were collected in both groups. RESULTS: In total, 168 patients were eligible; 82 (48.8%) were discharged, and 86 (51.2%) died postoperatively. Fewer prenatal visits (4.85 versus 6.05 visits, P = 0.004), delayed prenatal diagnosis (27.6 versus 22.2 weeks of gestational age, P = 0.005), low birth weight (2159 versus 2444 g, P < 0.001), intestinal injury (OR 5.5, P = 0.001) and sepsis (OR 112.1, P < 0.001) were associated with infantmortality. The type of delivery and the mean time between birth and the first corrective surgery (16.2 versus 21.1 h, P = 0.071) were not associated with increased neonatal mortality; however, the newborns who underwent their first corrective surgery after less than 4 h of life had lower mortality, and surgery performed after more than 4 h of life increased the risk of mortality (OR 2.7, CI 1.2-6.3, P 0.014). CONCLUSION: The mortality rate was high (51.2%) and was associated with inadequate prenatal care, low birth weight, gestational age, the severity of intestinal injury, infection and septicemia.