RESUMO
BACKGROUND: The Gastroschisis Prognostic Score (GPS) stratifies patients as high or low risk based on the visual assessment of intestinal matting, atresia, perforation, or necrosis. Despite being a simple score, its applicability to low and middle-income countries (LMICs) remains unknown. We tested the hypothesis that GPS can predict outcomes in LMICs, by assessing the prognostic value of the GPS in a middle-income country. METHODS: This prospective study followed all newborns with gastroschisis in a Brazilian neonatal unit based in a public hospital from 2015-2019. Infants were stratified into low and high-risk cohorts based on the GPS. In addition to basic demographics, data collected included duration of parenteral nutrition (TPN), mechanical ventilation (MV), length of stay (LOS), suspicion of infection that led to the use of antibiotics, and mortality. Univariate and multivariate analyses were conducted to identify which outcomes the GPS independently predicted. RESULTS: Sixty-one newborns with gastroschisis were treated during the study period. The mean birth weight, gestational age, and 5' Apgar score were 2258 g, 36 weeks, and 9. Twenty-four infants (39.3%) were identified as low-risk (GPS < 2) and 37 (60.7%) as high-risk (GPS > 2). The high-risk group presented with prolonged TPN use (p<0.001), MV (p<0.001), and LOS (p:0.002). GPS did not predict antibiotic therapy or mortality. CONCLUSION: In the first study in a middle-income country, the GPS predicted several important clinical outcomes. The GPS is a reliable tool for parental counseling and resource allocation in diverse settings. LEVEL OF EVIDENCE: II.c (cohort prospective).
Assuntos
Gastrosquise , Brasil , Pré-Escolar , Gastrosquise/diagnóstico , Gastrosquise/terapia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Prognóstico , Estudos Prospectivos , Estudos RetrospectivosRESUMO
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 surgical 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 prenatal diagnosis (90.9% vs. 60.0%, pâ¯<â¯0.001), delivery at a tertiary center (90.9% vs. 62.9%, pâ¯<â¯0.001), early closure (65.3% vs. 33.3%, pâ¯=â¯0.001), primary repair (55.4% vs. 31.4%, pâ¯=â¯0.013), monitoring of bladder pressure (62.0% vs. 2.9%, pâ¯=â¯0.001), PICC placement (71.1% vs. 25.7%, pâ¯<â¯0.001), early initiation of enteral feeding (54.5% vs. 20.0%, pâ¯<â¯0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, pâ¯=â¯0.001). Mortality decreased from 34.3% before 2002 to 24.8% (pâ¯=â¯.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.