Risk factors for adverse outcome of newborns with gastroschisis in a Brazilian hospital.
OBJECTIVE
The aim of this study was to determine the frequency of postoperative death and to identify factors associated with adverse prognosis in cases of gastroschisis managed in a tertiary hospital of Brazil.


METHODS
A retrospective transverse study was conducted including all cases of gastroschisis managed at Instituto Materno-Infantil De Pernambuco (IMIP), Recife, Brazil, between January 1995 and December 1999 (n = 31). Prevalence risk (PR) was determined for several prenatal, intraoperative, and postoperative factors.


RESULTS
Overall mortality rate was 52% (16 cases), and sepsis was the main cause of death (93.8%). Prenatal diagnosis reduced about 70% the risk of death. Preterm and low birth weight babies had about 3 times increase in the risk of death. Risk of death was increased twice among outborn babies, but there was no association with delivery route. Increase in risk of neonatal death was related to these other factors: birth-to-admission interval longer than 2 hours and birth-to-surgery interval longer than 4 hours. Prevalence risk also was greater with staged silo repair, poor clinical conditions before surgery, and when mechanical ventilation was needed.


CONCLUSIONS
A high mortality rate was associated with absence of prenatal diagnosis, prematurity, low birth weight, delivery outside the tertiary center, and delayed surgery, worsening clinical conditions that preclude primary closure and increases need of mechanical ventilation. J Pediatr Surg 36:559-564.
Departments of Pediatric Surgery and Gynecology, Instituto Materno-Infantil de Pernambuco, Rua dos Coelhos 300, Ilha do Leite, Recife, Pernambuco, Brazil, CEP:50070-550.
P C
PC
Vilela
M M
MM
Ramos De Amorim
G H
GH
Falbo
L C
LC
Santos
D001938:Brazil / Q000453:epidemiology; D013505:Digestive System Surgical Procedures; D005260:Female; D020139:Gastroschisis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D011336:Probability; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome