Improved mortality in gastroschisis patients after implementation of a standardized management bundle in central Malawi: A single-center follow-up at four years.

BACKGROUND

Gastroschisis is a congenital anomaly with >90 % survival in high-income countries. Despite advances in neonatal care, survival remains below 20 % in much of sub-Saharan Africa. We evaluate temporal changes in mortality and current predictors of mortality after implementing a standardized care bundle at a tertiary facility in Malawi.

METHODS

A retrospective, cross-sectional study included neonates admitted to Kamuzu Central Hospital between 7/1/2023 and 6/3/2024 with gastroschisis. In-hospital mortality was compared between this and a historical cohort (10/21/2019-11/30/2020). Both cohorts were treated under the same care bundle, which was newly implemented in 2019. Time-to-death analysis and logistic regression were used to understand predictors associated with contemporary in-hospital mortality.

RESULTS

The 2023-2024 cohort included 99 neonates, with a mean birth weight of 2.21 kg and a median gestational age of 36 weeks. Mortality decreased significantly to 71.7 % from 90.9 % in the 2019-2020 cohort (p = 0.005). 85.9 % of deaths occurred in the first 10 days of life. Bivariate analysis showed mortality was associated with female sex (p = 0.048), low birth weight (p = 0.002), and short length of stay (p < 0.001). Logistic regression identified birthweight <2 kg as a significant predictor of mortality (OR = 4.59, p = 0.03).

CONCLUSION

Mortality from gastroschisis has decreased over time following the implementation of a care bundle, with most deaths occurring in the first 10 days of life. The most significant predictor of mortality in the contemporary cohort was birthweight under 2 kg. These data may inform future targeted interventions to further decrease gastroschisis mortality.