title: Gastroschisis: Bellwether for neonatal surgery capacity in low resource settings?
abstract: BACKGROUND
  Economic disadvantage may adversely influence the outcomes of infants with gastroschisis (GS). Gastroschisis International (GiT) is a network of seven paediatric surgical centres, spanning two continents, evaluating GS treatment and outcomes.
  
  
  METHODS
  A 2-year retrospective review of GS infants at GiT centres. Primary outcome was mortality. Sites were classified into high, middle and low income country (HIC, MIC, and LIC). MIC and LIC were sometimes combined for analysis (LMIC). Disability adjusted life years (DALYs) were calculated and centres with the highest mortality underwent a needs assessment.
  
  
  RESULTS
  Mortality was higher in the LICs and LMICs: 100% in Uganda and Cote d'Ivoire, 75% in Nigeria and 60% in Malawi. 29% and 0% mortality was reported in South Africa and the UK, respectively. Septicaemia was the commonest cause of death. Averted and non-avertable DALYs were nil in Uganda and Cote d'Ivoire (no survivors). In the UK (100% survival) averted DALYs (met need) was highest, representing death and disability prevented by surgical intervention. Performance improvement measures were agreed: a prospectively maintained GS register; clarification of the key team members of a GS team and management pathway.
  
  
  CONCLUSIONS
  We propose the use of GS as a bellwether condition for assessing institutional capacity to deliver newborn surgical care. Early access to care, efficient multidisciplinary team working, appropriate resuscitation, avoidance of abdominal compartment syndrome, stabilization prior to formal closure and proactive nutritional interventions may reduce GS-associated burden of disease in low resource settings.
authors.affiliation: King's Centre for Global Health, London, UK; King's College Hospital, London, UK.
authors.forename: Kat
authors.initials: K
authors.lastname: Ford
authors.affiliation: MyungSung Christian Medical center, Addis Ababa, Ethiopia.
authors.forename: Dan
authors.initials: D
authors.lastname: Poenaru
authors.affiliation: Centre Hospitalier Universitairee, Treichville, Cote D'Ivorie.
authors.forename: Olivier
authors.initials: O
authors.lastname: Moulot
authors.affiliation: King's College Hospital, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Tavener
authors.affiliation: St George's Hospital, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bradley
authors.affiliation: Centre Hospitalier Universitairee, Treichville, Cote D'Ivorie.
authors.forename: Rouma
authors.initials: R
authors.lastname: Bankole
authors.affiliation: George Mukhari Academic Hospital, Pretoria, South Africa.
authors.forename: Nyaweleni
authors.initials: N
authors.lastname: Tshifularo
authors.affiliation: National Hospital, Abujah, Nigeria.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ameh
authors.affiliation: St Mary's, Lacor, Uganda.
authors.forename: Nelson
authors.initials: N
authors.lastname: Alema
authors.affiliation: Queen Elizabeth Hospital, Blantyre, Malawi.
authors.forename: Eric
authors.initials: E
authors.lastname: Borgstein
authors.affiliation: King's College Hospital, London, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Hickey
authors.affiliation: King's Centre for Global Health, London, UK; King's College Hospital, London, UK. Electronic address: adeajayi@doctors.org.uk.
authors.forename: Niyi
authors.initials: N
authors.lastname: Ade-Ajayi
mesh_terms: D000349:Africa / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D020139:Gastroschisis / Q000401:mortality / Q000601:surgery*; D006295:Health Resources; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D011203:Poverty; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013531:Surgicenters / Q000458:organization & administration / Q000600:supply & distribution; D006113:United Kingdom / Q000453:epidemiology
keywords: Bellwether; DALYs; Gastroschisis; Global surgery; Neonatal; Outcomes