Predicting mortality in neonates with gastroschisis in a Southeastern state of Brazil.

OBJECTIVE: This study aimed to verify risk factors associated with gastroschisis mortality in three neonatal intensive care units located in the state of Espírito Santo, Brazil. METHODS: A retrospective cohort study of neonates with gastroschisis was performed between 2000 and 2018. Prenatal, perinatal, and postsurgical variables of survival or nonsurvival groups were compared using chi-square statistical test, t-test, Mann-Whitney U test, and logistic regression. Tests with p<0.05 were considered statistically determined. RESULTS: A total of 142 newborns were investigated. Mean maternal age, gestational age, and birth weight were lower in the group of nonsurvival (p<0.05). Poor clinical conditions during admission, complex gastroschisis, closure with silo placement, the use of blood products, surgical complications, and short bowel syndrome were more frequent in the nonsurvival group (p<0.05). Complex gastroschisis [adjusted odds ratio (OR) 3.74, 95% confidence interval (95%CI) 1.274-11.019] and short bowel syndrome (adjusted OR 7.55, 95%CI 2.177-26.225) increased the risk of death. Higher birth weight inversely reduced the risk for mortality (adjusted OR 0.99, 95%CI 0.997-1.000). CONCLUSION: Complex gastroschisis and short bowel syndrome increased the risk of death, with greater birth weight being inversely correlated with the risk of mortality. The findings of this research can contribute to the formulation of protocols to improve the quality and safety of care in order to reduce neonatal mortality associated with gastroschisis.

Predicting mortality in neonates with gastroschisis in a Southeastern state of Brazil

SUMMARY OBJECTIVE: This study aimed to verify risk factors associated with gastroschisis mortality in three neonatal intensive care units located in the state of Espírito Santo, Brazil. METHODS: A retrospective cohort study of neonates with gastroschisis was performed between 2000 and 2018. Prenatal, perinatal, and postsurgical variables of survival or nonsurvival groups were compared using chi-square statistical test, t-test, Mann-Whitney U test, and logistic regression. Tests with p<0.05 were considered statistically determined. RESULTS: A total of 142 newborns were investigated. Mean maternal age, gestational age, and birth weight were lower in the group of nonsurvival (p<0.05). Poor clinical conditions during admission, complex gastroschisis, closure with silo placement, the use of blood products, surgical complications, and short bowel syndrome were more frequent in the nonsurvival group (p<0.05). Complex gastroschisis [adjusted odds ratio (OR) 3.74, 95% confidence interval (95%CI) 1.274-11.019] and short bowel syndrome (adjusted OR 7.55, 95%CI 2.177-26.225) increased the risk of death. Higher birth weight inversely reduced the risk for mortality (adjusted OR 0.99, 95%CI 0.997-1.000). CONCLUSION: Complex gastroschisis and short bowel syndrome increased the risk of death, with greater birth weight being inversely correlated with the risk of mortality. The findings of this research can contribute to the formulation of protocols to improve the quality and safety of care in order to reduce neonatal mortality associated with gastroschisis.

Gastroschisis in Brazil within a Global Context / Gastrosquise no Brasil em um Contexto Global

Introduction: global disparity in outcomes of gastroschisis is visible. Survival rates in high-income countries have improved since 1960, and are currently around 100%, due to progress in pediatric surgery and neonatal intensive care. However, in low- and middle-income countries mortality rates can reach all cases. Objective: this study aims to map the existing literature on gastroschisis in Brazil within a global context.Methods: scoping Review. PubMed, Scielo Brazil, Biblioteca Virtual em Saúde (BVS) and Google Scholar, were searched from January 2000 to May 2020.Results: eight studies met the inclusion criteria. The consolidated data of 912 patients were: Mean maternal age of 20.7 years, antenatal diagnosis rate of 80.2%, cesarean section rate of 77.7%. Mean of hospital stay of 40.8 days. Mean mortality rate of 25.3 %. Risk factors associated with death were: prematurity, low birth weight, low APGAR score, reinterventions, sepsis, birth-to-surgery interval greater than 4 hours, fewer prenatal visits, delayed prenatal diagnosis.Conclusion: studies on gastroschisis in Brazil were scarce, most of carried out in southeast of country. This study suggests that there are regional contrasts on gastroschisis outcomes in Brazil. The worst results are in regions with low economic resources, a similar situation found in international literature. This review should be validated with future studies to investigate the situation of pregnant women with fetuses with gastroschisis, especially in low-resource regions, in Brazil.

Introdução: a disparidade global nos resultados da gastrosquise é visível. Taxas de sobrevivência em países de alta renda melhoraram desde 1960 e atualmente estão em torno de 100%, devido ao progresso da cirurgia pediátrica e da terapia intensiva neonatal. No entanto, em países de media e baixa renda, as taxas de mortalidade continual elevadas. Objetivo: este estudo tem como objetivo mapear a literatura existente sobre gastrosquise no Brasil e discutir as evidências disponíveis em um contexto global.Método: revisão de escopo. Foram pesquisados o PubMed, o Scielo Brasil, a Biblioteca Virtual em Saúde (BVS) e o Google Scholar no período de janeiro de 2000 a maio de 2020.Resultados: oito estudos preencheram os critérios de inclusão e os dados encontrados de 912 pacientes foram: idade materna média de 20.7 anos, média do diagnóstico antenatal de 80.2%, taxa média de cesarianas de 77.7%, tempo de permanência hospitalar médio de 40.8 dias e taxa média de mortalidade 25.3%. Os fatores de risco associados ao óbito encontrados foram a prematuridade, baixo peso ao nascer, APGAR baixo, reintervenções cirúrgicas, sepse, intervalo nascimento-cirurgia maior que 4 horas, poucas consultas do pré-natal e diagnóstico antenatal tardio.Conclusão: estudos sobre gastrosquise no Brasil são escassos, a maioria realizada no Sudeste do país. Os piores desfechos estão em regiões com poucos recursos econômicos, situação semelhante à encontrada na literatura internacional. Esta revisão deve ser validada com estudos futuros que investiguem a situação de gestantes portadoras de fetos com gastrosquise, especialmente em regiões de poucos recursos, no Brasil.

Influence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil

Abstract Objective: To characterize the influence of birthplace on outcomes of patients with gastroschisis admitted to three hospitals in a state in Brazil's southeastern region, according to condition inborn (born in a reference center) or outborn (born outside the reference center). Methods: Retrospective multicenter cohort study of patients with gastroschisis. The sample size utilized was of patients admitted in three hospitals with a diagnosis of gastroschisis ICD 10 Q79.3 between January 2000 to December 2018. Patients were divided into two groups, inborn and outborn. Characteristics of prenatal, perinatal and postoperative were compared using statistical tests. The level of significance adopted was P-value < 0.05. Results: In total, 144 cases of gastroschisis were investigated. The outborn patients group had higher rates of absence of antenatal diagnosis (p = 0.001), vaginal delivery (p = 0.001), longer time between birth and abdominal wall closure surgery (p = 0.001), to silo removal (p = 0.001), to first enteral feeding (p = 0.008), for weaning from mechanical ventilation (p = 0.034), used less peripherally inserted central catheter (PICC) and required more venous dissections (p = 0.001), and lower mean of serum sodium (p = 0.015). There were no differences in mortality rates and length of hospital stay between the inborn and outborn groups. Conclusion: Although outborn patients with gastroschisis were less likely to have an antenatal diagnosis and were more prone to a longer time to undergo surgical and feeding procedures, and to spend more time in mechanical ventilation, these disadvantages seemed not to reflect on the death rate and the length of hospital stay of patients from this group.

Influence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil.

OBJECTIVE: To characterize the influence of birthplace on outcomes of patients with gastroschisis admitted to three hospitals in a state in Brazil's southeastern region, according to condition inborn (born in a reference center) or outborn (born outside the reference center). METHODS: Retrospective multicenter cohort study of patients with gastroschisis. The sample size utilized was of patients admitted in three hospitals with a diagnosis of gastroschisis ICD 10 Q79.3 between January 2000 to December 2018. Patients were divided into two groups, inborn and outborn. Characteristics of prenatal, perinatal and postoperative were compared using statistical tests. The level of significance adopted was P-value < 0.05. RESULTS: In total, 144 cases of gastroschisis were investigated. The outborn patients group had higher rates of absence of antenatal diagnosis (p = 0.001), vaginal delivery (p = 0.001), longer time between birth and abdominal wall closure surgery (p = 0.001), to silo removal (p = 0.001), to first enteral feeding (p = 0.008), for weaning from mechanical ventilation (p = 0.034), used less peripherally inserted central catheter (PICC) and required more venous dissections (p = 0.001), and lower mean of serum sodium (p = 0.015). There were no differences in mortality rates and length of hospital stay between the inborn and outborn groups. CONCLUSION: Although outborn patients with gastroschisis were less likely to have an antenatal diagnosis and were more prone to a longer time to undergo surgical and feeding procedures, and to spend more time in mechanical ventilation, these disadvantages seemed not to reflect on the death rate and the length of hospital stay of patients from this group.

Desempenho do Pediatric Index of Mortality 2 em unidade de cuidados intensivos pediátrica / Performance of the Pediatric Index of Mortality 2 in a pediatric intensive care unit

Objetivo: Avaliar a discriminação e a calibração do Pediatric Index of Mortality 2 em pacientes de uma unidade de cuidados intensivos pediátrica. Métodos: Estudo de coorte contemporânea realizado no período de novembro de 2005 a novembro de 2006. Os limites de idade foram 29 dias de vida e 18 anos. Excluídos aqueles com óbito em menos de 12 horas após admissão e readmissões. Para o desempenho do Pediatric Index of Mortality 2, foram aplicados o teste de Hosmer-Lemeshow, o índice padronizado de mortalidade standardized mortality ratio e área sob a curva ROC, intervalo de confiança de 95%. O nível de significância foi de 5%. Resultados: Foram estudadas 276 admissões de pacientes. A taxa de mortalidade foi de 14,13%, com eficiência de admissão de 0,88%. A mediana de idade foi de 42,22 meses, havendo predomínio do gênero masculino com 60,1%. O setor de emergência foi responsável por 48,91% das admissões. Tempo de permanência foi de 6,43±5,23 dias (média). As admissões clínicas corresponderam a 72,46% e associaram-se ao óbito (odds ratio: 2,9; intervalo de confiança de 95%: 1,09-7,74; p=0,017). O Pediatric Index of Mortality 2 apresentou calibração com qui-quadrado de 12,2686 (p=0,1396) no teste de Hosmer-Lemeshow, e índice padronizado de morte de 1,0. A discriminação relacionada à área abaixo da curva ROC foi de 0,778. Conclusão: O escore Pediatric Index of Mortality 2 apresentou desempenho satisfatório. .

Objective: To assess the discrimination and calibration of the Pediatric Index of Mortality 2 in patients admitted to a pediatric intensive care unit. Methods: The study was conducted with a contemporary cohort from November 2005 to November 2006. Patients aged 29 days to 18 years were included in the study. Patients who died within 12 hours of admission and cases of readmission were excluded from the study. The performance of the Pediatric Index of Mortality 2 was assessed by means of the Hosmer-Lemeshow goodness-of-fit test, the standardized mortality ratio and the area under receiver operating characteristic (ROC) curve with 95% confidence interval. The significance level was established as 5%. Results: A total of 276 admissions to the pediatric intensive care unit were included in the analysis. The mortality rate was 14.13%, and the efficiency of admission 0.88%. The median age of the sample was 42.22 months, and most participants were male (60.1%). Most admissions were referrals from the emergency department. The mean duration of stay in pediatric intensive care unit was 6.43±5.23 days. Approximately 72.46% of admissions were for clinical reasons and exhibited an association with the outcome death (odds ratio: 2.9; 95%CI: 1.09-7.74; p=0.017). Calibration of the Pediatric Index of Mortality 2 with the chi-square statistic was 12.2686 (p=0.1396) in the Hosmer-Lemeshow goodness-of-fit test, and the standardized mortality ratio was 1.0. The area under the ROC curve assessing model discrimination was 0.778. Conclusion: Pediatric Index of Mortality 2 exhibited satisfactory performance. .