Abstract
Background: The anterior abdominal defects, especially gastroschisis and omphalocele have high mortality rates in developing countries. Time to intervene has been hypothesized to be associated with morbidity and mortality. The aim was to determine factors affecting mortality in neonates with anterior abdominal wall defects. Methods: This retrospective descriptive study was done at a tertiary pediatric care center. The medical records of patients with a diagnosis of anterior abdominal defects (omphalocele/gastroschisis/umbilical cord hernia) admitted at our center from Jan 2015 to Dec 2019 were retrieved. The demographic and clinical data were studied including age, sex, religion, gestational age, associated anomalies, electrolytes at admission, septic profile, operative details, length of hospital stay, and mortality. The statistical data was fed on a Microsoft Excel worksheet and analysis was done. Results: Thirty-nine (39) neonates were included in the study. M:F ratio was 2:1, with 61.5% belonging to the Hindu religion. The majority had term gestation (87.2%). Birth weight ranged from 1.5 to 4 kg (mean 2.47 + 0.5 kg). Eighteen (18) neonates had gastroschisis, 15 omphalocele major and 6 omphalocele minor, with a median age of presentation at 1 day of life. Time to intervention ranged from 0 to 5 days (interquartile range 1-1.25 days) after admission. Primary closure could be achieved in the majority (66.7%), while ventral hernia was created in 17.9% and the silo was needed in the rest. The mean postoperative length of stay was 9.31 days (+ 9.85 days) with a survival rate of 51.3%. The mortality rate in gastroschisis and omphaloceles were 61.1% and 38.1% respectively. The significant factors for survival were time to intervene, birth weight, and primary abdominal wall closure. Conclusions: The present study brings out a different clinical profile of anterior abdominal wall defect patients. We recommend early surgery soon after stabilization and primary abdominal wall repair whenever abdominal pressures permit.
Highlights
The gastroschisis and omphalocele account for the most common anterior abdominal wall defects, with an incidence of 1:12000 and 1:4000 live births, respectively.[1,2] In gastroschisis, usually small intestine, occasionally stomach or colon lies outside body cavity without any protective sac or membranes
The hospital medical records from Jan 2015 to Dec 2019 were retrieved to find out cases of anterior abdominal wall defects
All neonates presenting with anterior abdominal wall defects were included in the study, while those presenting late after escharization were excluded from the study
Summary
The gastroschisis and omphalocele account for the most common anterior abdominal wall defects, with an incidence of 1:12000 and 1:4000 live births, respectively.[1,2] In gastroschisis, usually small intestine, occasionally stomach or colon lies outside body cavity without any protective sac or membranes. Non-intestinal anomalies, including cardiac defects and pulmonary hypoplasia, are reported in up to 24% to 50% of omphalocele cases.[3,4,5,6,7] The overall survival in gastroschisis is 92–96% in the developed world and prognosis is determined by the degree of injury to the bowel, the severity of illness in the first week of life, and the immediate post-operative recovery.[8,9] The mortality in omphalocele is higher (20%) and may be related to other anomalies including intestinal atresia, cardiac defects, or pulmonary hypoplasia.[3,10] These anomalies and their severity affect survival rates for live-born children with omphalocele.[11] We did this retrospective study to estimate the mortality rate in neonates with anterior abdominal wall defects and whether there is any difference in the same as compared to various other western studies. The aim was to determine factors affecting mortality in neonates with anterior abdominal wall defects
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