Journal of pediatric surgery · 2026
Establishing gastroschisis care: Impact of pediatric surgical services and a dedicated neonatal surgical unit on survival of gastroschisis in Rwanda.
СтатьяНазвание и аннотация: Перевод в очереди
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Hsu Phillip J, Diehl Thomas M, Lemma Michael Adam, Javed Mohammed, Rwagahirima Elisée, Ntezamizero Japhet, Nduwimana Axelle-Aimee, Bunogerane Gisèle Juru, Ndibanje Alain-Jules, Matusko Niki, Petroze Robin T, Ntaganda Edmond
Аннотация
INTRODUCTION: Gastroschisis has historically been fatal in resource-limited settings, where lack of prenatal diagnosis, surgical neonatal care, and parenteral nutrition challenge replication of western care paradigms. We present a Rwandan tertiary center's experience managing gastroschisis and outcomes before and after opening a neonatal surgical unit.
METHODS: Patients with gastroschisis admitted to the main referral hospital in Rwanda were included. A neonatal surgery unit opened 3/2020. Data was collected from 1/2016-8/2022. Descriptive, bivariate, and multivariate statistics were performed.
RESULTS: 338 patients with gastroschisis were studied. Incidence was estimated at 3.8/10,000 live births. 30.2% of patients survived, with mean length of stay of 28.6 (IQR 21-32) days. Survivors, compared to those who died, were born at older gestational age, had lower rates of complex gastroschisis, were more likely to undergo abdominal closure, and had enteral feeds started earlier. Survival was seen at gestational ages as young as 30 weeks and with birth weights as low as 1.5 kg. After opening a neonatal surgical unit, gastroschisis admissions increased 2.6-fold, and survival appeared to increase (22.8% vs. 32.9%, p = 0.076).
CONCLUSION: Through development of pediatric surgical capacity and systems changes, gastroschisis is survivable in an LMIC setting. Establishment of a neonatal surgical unit was associated with the ability to handle higher volumes of gastroschisis patients, with consistent and improving outcomes. Challenges include treatment of complicated patients, including those with complex gastroschisis. Ongoing experience and prospective data collection will guide initiatives to improve gastroschisis outcomes in Rwanda and support innovation for neonatal care in resource-limited settings.
METHODS: Patients with gastroschisis admitted to the main referral hospital in Rwanda were included. A neonatal surgery unit opened 3/2020. Data was collected from 1/2016-8/2022. Descriptive, bivariate, and multivariate statistics were performed.
RESULTS: 338 patients with gastroschisis were studied. Incidence was estimated at 3.8/10,000 live births. 30.2% of patients survived, with mean length of stay of 28.6 (IQR 21-32) days. Survivors, compared to those who died, were born at older gestational age, had lower rates of complex gastroschisis, were more likely to undergo abdominal closure, and had enteral feeds started earlier. Survival was seen at gestational ages as young as 30 weeks and with birth weights as low as 1.5 kg. After opening a neonatal surgical unit, gastroschisis admissions increased 2.6-fold, and survival appeared to increase (22.8% vs. 32.9%, p = 0.076).
CONCLUSION: Through development of pediatric surgical capacity and systems changes, gastroschisis is survivable in an LMIC setting. Establishment of a neonatal surgical unit was associated with the ability to handle higher volumes of gastroschisis patients, with consistent and improving outcomes. Challenges include treatment of complicated patients, including those with complex gastroschisis. Ongoing experience and prospective data collection will guide initiatives to improve gastroschisis outcomes in Rwanda and support innovation for neonatal care in resource-limited settings.