Infectious complications in infants with gastroschisis: an 11-year review from a referral hospital in southern Thailand.
MAIN PURPOSES: The study aimed to (1) examine the incidence of infectious complications (ICs) in our referral hospital in southern Thailand in infants with gastroschisis, with analysis of the impact of these complications on outcomes, and (2) identify associated factors to improve the practice at our institution for dealing with this condition.


METHODS
A retrospective review of consecutive gastroschisis cases at the major teaching and referral hospital in southern Thailand was conducted for an 11-year period (1996-2006). Cases referred after a primary operation at other hospitals were excluded. The study focused on postoperative nosocomial infections as identified by Centers for Disease Control and Prevention criteria.


RESULTS
Sixty-eight patients with gastroschisis were operated on. Twenty-seven patients (39.71%) underwent primary closure. Mortality was 4 of 68 patients (5.9%). Infectious complication occurred in 43 patients (63.2%). The complications significantly increased mechanical ventilation days (10.8 vs 3.8 days in noncomplicated cases), need for parenteral nutrition (25.3 vs 14.5 days), and postoperative stay (33.7 vs 21.1 days). Common ICs were wound infection (32.35%), isolated septicemia (19.1%), and pneumonia (13.24%). Univariate analysis identified an association between the occurrence of IC and birth order (multigravida), time from birth until arrival at our center (5 hours or more), hypoalbuminemia, hypoglycemia, type of operation (staged closure), use of central venous line, and prolonged use of ventilator. On multiple logistic regression, prolonged referral time, use of a central venous line, multigravida, and staged closure independently predicted the risk of IC.


CONCLUSIONS
Infectious complication was significantly related to outcome in gastroschisis cases and should not be overlooked. Our data suggest that prompt referral, limiting central line practice on a selective basis, and an attempt to reduce wound infection in cases that require a temporary silo may improve the overall outcomes.
Sangkhathat
Surasak
S
Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla 90110, Thailand. surasak.sa@psu.ac.th
Patrapinyokul
Sakda
S
Chiengkriwate
Piyawan
P
Chanvitan
Prasin
P
Janjindamai
Waricha
W
Dissaneevate
Supaporn
S
D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011336:Probability; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015996:Survival Rate; D013785:Thailand / Q000453:epidemiology