Highlights
- •The Gastroschisis Prognostic Score (GPS) is a simple and accurate risk stratification and prognostic tool for gastroschisis. The GPS had never been tested previously in low- and middle-income countries.
- •In a Brazilian center, the GPS reliably predicted several important clinical outcomes, including duration of parenteral nutrition, mechanical ventilation, and length of stay.
Abstract
Background
The Gastroschisis Prognostic Score (GPS) stratifies patients as high or low risk based
on the visual assessment of intestinal matting, atresia, perforation, or necrosis.
Despite being a simple score, its applicability to low and middle-income countries
(LMICs) remains unknown. We tested the hypothesis that GPS can predict outcomes in
LMICs, by assessing the prognostic value of the GPS in a middle-income country.
Methods
This prospective study followed all newborns with gastroschisis in a Brazilian neonatal
unit based in a public hospital from 2015–2019. Infants were stratified into low and
high-risk cohorts based on the GPS. In addition to basic demographics, data collected
included duration of parenteral nutrition (TPN), mechanical ventilation (MV), length
of stay (LOS), suspicion of infection that led to the use of antibiotics, and mortality.
Univariate and multivariate analyses were conducted to identify which outcomes the
GPS independently predicted.
Results
Sixty-one newborns with gastroschisis were treated during the study period. The mean
birth weight, gestational age, and 5ʼ Apgar score were 2258 g, 36 weeks, and 9. Twenty-four
infants (39.3%) were identified as low-risk (GPS < 2) and 37 (60.7%) as high-risk
(GPS > 2). The high-risk group presented with prolonged TPN use (p<0.001), MV (p<0.001), and LOS (p:0.002). GPS did not predict antibiotic therapy or mortality.
Conclusion
In the first study in a middle-income country, the GPS predicted several important
clinical outcomes. The GPS is a reliable tool for parental counseling and resource
allocation in diverse settings.
Level of evidence
II.c (cohort prospective)
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
CAPSNet (Canadian Pediatric Surgery Network), HC-UFMG (Hospital das Clínicas of Federal University of Minas Gerais), GPS (Gastroschisis Prognostic Score), LMICs (low- and middle-income countries (LMICs)), LOS (Length of Stay), MV (Mechanical Ventilation), TPN (Parenteral Nutrition)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 23, 2022
Accepted:
February 12,
2022
Received in revised form:
January 31,
2022
Received:
August 31,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
