title: Mortality-related factors in gastroschisis - a Jamaican perspective.
abstract: OBJECTIVE
  To determine the mortality rate of patients treated with gastroschisis at a Jamaican pediatric hospital, and to identify factors that contribute significantly to mortality.
  
  
  METHODS
  Eighty-five patients were treated with gastroschisis between November 1, 2006 and November 30, 2015. Of these, 80 records were recovered and reviewed retrospectively. Records were analyzed for maternal and patient characteristics, and details of the clinical course. Death during admission was the primary outcome measure.
  
  
  RESULTS
  63 of the 80 patients died during admission, giving a mortality rate of 78.8%. Sepsis was the main cause of death (82.4%). 27 patients (33.8%) had complicated gastroschisis (necrosis, perforation and/or atresia), all of whom died. Only preterm gestational age, complicated gastroschisis, and the lack of parenteral nutrition were found to be statistically associated with increased mortality.
  
  
  CONCLUSIONS
  Our mortality rate is higher than those quoted in high-income countries, and correlates to those found in low- to middle-income countries. Mortality in our cohort was significantly associated with prematurity, complicated gastroschisis, and the lack of parenteral nutrition. Efforts to improve outcome must focus on improving antenatal care, establishing transfer protocols, and optimizing nutrition for all patients with gastroschisis.
  
  
  METHODS
  Prognostic/Retrospective Study LEVEL OF EVIDENCE: Level II.
authors.affiliation: Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies. Electronic address: smarshall15@yahoo.com.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Marshall Niles
authors.affiliation: Department of Community Health and Psychiatry, University of the West Indies, Mona Campus, Kingston 7, Jamaica, West Indies.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Mitchell-Fearon
authors.affiliation: Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies.
authors.forename: Mitchell I
authors.initials: MI
authors.lastname: Gill
authors.affiliation: Department of Pediatric Surgery, University Hospital of the West Indies, Mona, Kingston 7, Jamaica, West Indies.
authors.forename: Claudine J
authors.initials: CJ
authors.lastname: DeSouza
authors.affiliation: Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Fearon
authors.affiliation: Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Abel
authors.affiliation: Department of Anaesthesia and Intensive Care, Bustamante Hospital for Children.
authors.forename: Brian A
authors.initials: BA
authors.lastname: James
authors.affiliation: Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies.
authors.forename: Noel J
authors.initials: NJ
authors.lastname: McLennon
mesh_terms: D000328:Adult; D005260:Female; D020139:Gastroschisis / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D005865:Gestational Age; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000601:surgery / Q000628:therapy; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D009035:Mothers; D010288:Parenteral Nutrition; D010289:Parenteral Nutrition, Total; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D055815:Young Adult
keywords: Complicated gastroschisis; Gastroschisis; Mortality-related factors; Outcome