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Type:	Artigo de Periódico
Title:	A 25-year study of gastroschisis outcomes in a middle-income country
Authors:	Marcelo Ellermiranda Sherif Emil Ricardo de Mattos Paixão Clécio Piçarro Paulo Custódio Furtado Cruzeiro Bernardo Almeida Campos Andrey Kaliff Pontes Edson Samesima Tatsuo
Abstract:	Background: Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management. Methods: All newborns with gastroschisis treated during the period 1989–2013 at a single Brazilian academic surigical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis. Results: One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of pre natal diagnosis (90.9% vs. 60.0%, p b 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p b 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p b 0.001), early initiation of enteral feeding (54.5% vs.20.0%, p b 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period. Conclusions: Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols. Type of Study: Therapeutic. Level of Evidence:III
Subject:	Gastrosquise Brasil Países Desenvolvidos Países em Desenvolvimento Recém-nascido
language:	eng
metadata.dc.publisher.country:	Brasil
Publisher:	Universidade Federal de Minas Gerais
Publisher Initials:	UFMG
metadata.dc.publisher.department:	MED - DEPARTAMENTO DE CIRURGIA
Rights:	Acesso Aberto
metadata.dc.identifier.doi:	10.1016/j.jpedsurg.2019.02.020
URI:	http://hdl.handle.net/1843/53216
Issue Date:	17-Feb-2019
metadata.dc.url.externa:	https://www.sciencedirect.com/science/article/pii/S002234681930137X?via%3Dihub
metadata.dc.relation.ispartof:	Journal of Pediatric Surgery
Appears in Collections:	Artigo de Periódico

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